Tom Giannulli, MD, MS

The healthcare industry has been ready for an overhaul of the Meaningful Use program, and 

CMS Administrator Seema Verma announced at the HIMSS18 conference this month

 that the agency is prepared to deliver. What can physicians expect? An increased focus on interoperability that provides timely access to health information combined with updated and streamlined evaluation and management (E/M) billing requirements that will allow physicians to spend less time using their EHRs and more time seeing patients.

This all bodes well for physicians-particularly those who continue to struggle with productivity when using EHRs. Forty-six percent of practices report seeing fewer patients now that they have an electronic record. It’s easy to blame the EHR for this problem. Yet, in every other industry, technology has only made people 

 efficient. Why hasn’t this happened in healthcare?

To understand the answer to this question, we need to examine the background against which physicians have implemented EHRs. First, providers practice in a highly regulated healthcare environment. Documentation is their greatest asset because it drives payment and publicly reported outcomes data. This wasn’t the case pre-EHRs when most physicians talked briefly with patients, performed a quick exam, scribbled a few words on a piece of paper, and moved on to their next patient. For the most part, payers paid regardless of the words physicians used to describe their services.

Now, payer requirements are far more stringent, and physicians must meet a whole host of quality metrics to be paid accurately. It’s a different world. For every hour that physicians spend with patients, they spend two hours on EHRs and desk work. Thirty-eight percent of physicians spend 10-19 hours per week on paperwork.

Second, providers practice in a highly litigious environment absent of medical liability tort reform. Physicians often document information that may not even be clinically relevant out of fear that they’ll be sued for medical malpractice and owe excessive amounts of money. The more time physicians spend documenting, the less time they spend seeing patients.

The good news is that physicians can take simple steps to reduce the time they spend using the EHR. Consider the following:

 Copy and paste or “copy forward” functions have gotten a bad reputation over the years because some physicians have used them to exaggerate the work they perform. For example, providers clearly shouldn’t copy a level four evaluation and management visit and paste it into an encounter for a sore throat. However, when used correctly (i.e., by taking a few seconds to validate that the information is appropriate and relevant), copy and paste saves considerable time. In addition, every physician should use disease-specific templates to facilitate documentation expediency. When available, physicians should also take advantage of predetermined care plans that include disease order sets for labs, tests, and medications.

One of the most common documentation-related complaints I hear is that physicians must document data points for the 

Merit-based Incentive Payment System (MIPS)

 in addition to the charting duties in the normal workflow. This is essentially double the workload to provide the same exact information. Some EHRs are making progress to reduce this burden, for instance, by providing a reporting dashboard that allows physicians to select measures and easily pull them into a report. Eventually, artificial intelligence (AI) will solve this problem altogether. Vendors will create AI-driven technology that extracts quality data directly from the narrative itself. We’re not there yet, but it’s only a matter of time before AI is widely used for a sustainable solution.

 Delegation is the key to survival under value-based payment models. Physicians can’t possibly fulfill quality metrics and document necessary details while continuing to see the same number of patients. Care managers play a critical role in engaging at-risk patient populations. When practices hire these individuals, they may also be able to more easily bill for chronic care management, transitional care management, and psychiatric collaborative care-three services that help optimize value-based payments.

In-person and virtual scribes are another option. At a 

, medical scribes help physicians focus on patient care without the hassle of burdensome documentation requirements.

 This could be a medical coder or administrative staff member who has undergone vendor training and who can serve as an internal resource when EHR-related questions arise (e.g., how to create a new template or update a “favorites” list). It’s like having a support tech embedded within your practice. Be sure to incentivize this individual with a bonus or a raise to reward them for their knowledge.

It’s time for physicians to rewrite the narrative on EHRs. Vendors aren’t perfect, but many are striving to improve the technology so that it better aligns with value-based payment models. Likewise, physicians need to give EHRs a fair shot. They need to use the technology to its fullest capacity and also look beyond it to create workflows that support value-based care.

 is a board-certified internist and the chief medical information officer at 

a provider of technology-enabled solutions for independent physician practices.

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