Improved design, workflow optimization may reduce EHR burden for oncologists
Electronic health records appear to pose a considerable burden for oncologists, according to study results.
Although oncologists spent less time per appointment using EHRs than clinicians from other specialties, they received more EHR results and system-generated messages than other specialists. They also appeared less likely to use tools designed to increase EHR efficiency, results showed.
“We know that, subjectively, many people feel that EHR burden has increased dramatically in the past several years, but I think it’s worthwhile to consider what elements of EHR specifically are driving that burnout,” study lead author Sumi Sinha, MD, clinical instructor in the department of radiation oncology at University of California, San Francisco, told Healio. “There is a lot of effort being made to ease those burdens but, without data to support them, these are blind efforts. We’re just hoping to see how we can maximize the punch when we reduce these burdens.”
Sinha and colleagues analyzed Epic EHR system usage data from 349 health care systems over an 8-month period in 2019. Researchers compared time spent in the system, message volume and note composition.
Oncologists spent less time per appointment in the HER system (– 3.1 minutes; 95% CI, – 3.69 to – 2.52 minutes; P < .001) than other specialists, such as pulmonologists, cardiologists or orthopedists.
However, oncologists received more HER results and system-generated messages per day (28.3 vs. 25.4; P < .001). They also were less likely to use efficiency tools such as SmartPhrases, a feature that inserts text or data into a clinical note.
Healio spoke with Sinha about the insights gained from the study, as well as how this information could help refine EHR and reduce the burden for oncologists.
Healio: How did you conduct this study?
Sinha: We looked at a single EHR system in this analysis, the Epic System. It’s one of the most commonly used systems, and they have cross-sectional data from across the United States. We looked at the data to determine when oncologists interact with EHR and the types of work they are doing. We targeted two areas that we know are high for oncologists. The first is notes documentation — how do oncologists go about writing clinical notes? The second was an analysis of the EHR inbox. Oncologists receive messages from multiple sources every day through the EHR system. We drilled down on what types of messages oncologists are receiving and how that compares with other specialties.
Healio: What did you find?
Sinha: With respect to note composition, we found that a higher percentage of oncologists’ notes are derived from copy/paste functions, meaning they are copying and pasting text from a prior note into their new note. Similarly, they’re using SmartPhrases less frequently. SmartPhrases are text in the note that is pulled from somewhere else in the EHR and automatically updated by the EHR itself. An example of a SmartPhrase would be the patient’s age. If you copy and paste the patient’s age, it’s prone to errors. If the birthday passes, that data is no longer correct. A SmartPhrase auto-updates that text. There are many oncology-specific examples of smart phrases that are not being used by oncologists in their notes. We know this contributes to what’s called “note bloat” — the notes become longer but aren’t necessarily more accurate.
The other big finding in this study pertains to messages. We found that oncologists receive more system-generated messages than clinicians from other medical specialties. This is very interesting because we know specifically that system-generated messages are tied to burnout. That was one finding that identifies a specific pain point for oncologists in the EHR system.
System-generated messages could include lab or imaging results for a patient. For example, if a patient has a CT scan, the results of that scan are automatically sent to their providers. That could include the oncologist, but the point is that sometimes these messages are relevant to patient care and sometimes they’re not. A better mechanism to triage those messages probably would be helpful to oncologists.
Overall, our study showed oncologists tended to spend less time in the EHR per appointment, and they also spend less time in the EHR overall compared with providers in other medical specialties. We know time spent on EHR is a large source of burnout, so that could be one area where oncologists are perhaps faring a bit more favorably than other medical specialties. However, the caveat is that some oncology specialties spend time in a separate EHR. For example, I’m a radiation oncologist, and I complete documentation both in Epic and in a radiation oncology-specific EHR. So, the finding of spending less time in the EHR might not be entirely accurate.
Healio: What can be done to reduce the HER burden for oncologists?
Sinha: A better mechanism with which to triage those messages probably would be helpful to oncologists. Additionally, I believe there should be some general awareness about the sources of burnout for oncologists, in particular. This study points to some specific areas of burnout that oncologists should be aware of, such as system-generated messages. When it comes to note composition, oncologists should be mindful of tools that might ease the burden of notes, such as smart phrases. Another interesting area is the system-level improvements that we could make — better triaging of messages for oncologists, and a bit more specialization of EHR systems toward the specific needs of oncologists.
Reference:
For more information:
Sumi Sinha, MD, can be reached at University of California, San Francisco, 1600 Divisadero St., #H1029, San Francisco, CA 94115; email: sumi.sinha@ucsf.edu.
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