A Mobile, Electronic Health Record-Connected Application for Managing Team Workflows in Inpatient Care

Ballester, Jacqueline M. Soegaard; Bass, Geoffrey D.; Urbani, Richard; Fala, Glenn; Patel, Rutvij; Leri, Damien; Steinkamp, Jackson; Denson, Joshua L.; Rosin, Roy; Adusumalli, Srinath; Hanson, C. William; Koppel, Ross; Airan-Javia, Subha

doi:10.1055/s-0041-1740256

Cited by 7 publications

(7 citation statements)

References 44 publications

(55 reference statements)

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“…To address these other contributors to clinical workflow inefficiencies, researchers are developing and building redesigned EHRs that promote communication and facilitate team-based approaches to clinical care. 11,54 Similarly, several of the studies describing medical scribe use noted that it did not inherently reflect a reduction in total documentation volume but rather a transfer of documentation burden to another member of the care team. Additionally, several of the efforts were aimed at educating clinicians to improve efficiency in documenting rather than reducing the total volume of documentation.…”

Section: Discussionmentioning

confidence: 99%

Toward Alleviating Clinician Documentation Burden: A Scoping Review of Burden Reduction Efforts

Sloss,

Abdul,

Aboagyewah

et al. 2024

Appl Clin Inform

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Background Studies have shown that documentation burden experienced by clinicians may lead to less direct patient care, increased errors, and job dissatisfaction. Implementing effective strategies within health care systems to mitigate documentation burden can result in improved clinician satisfaction and more time spent with patients. However, there is a gap in the literature regarding evidence-based interventions to reduce documentation burden. Objectives The objective of this review was to identify and comprehensively summarize the state of the science related to documentation burden reduction efforts. Methods Following Joanna Briggs Institute Manual for Evidence Synthesis and Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines, we conducted a comprehensive search of multiple databases, including PubMed, Medline, Embase, CINAHL Complete, Scopus, and Web of Science. Additionally, we searched gray literature and used Google Scholar to ensure a thorough review. Two reviewers independently screened titles and abstracts, followed by full-text review, with a third reviewer resolving any discrepancies. Data extraction was performed and a table of evidence was created. Results A total of 34 articles were included in the review, published between 2016 and 2022, with a majority focusing on the United States. The efforts described can be categorized into medical scribes, workflow improvements, educational interventions, user-driven approaches, technology-based solutions, combination approaches, and other strategies. The outcomes of these efforts often resulted in improvements in documentation time, workflow efficiency, provider satisfaction, and patient interactions. Conclusion This scoping review provides a comprehensive summary of health system documentation burden reduction efforts. The positive outcomes reported in the literature emphasize the potential effectiveness of these efforts. However, more research is needed to identify universally applicable best practices, and considerations should be given to the transfer of burden among members of the health care team, quality of education, clinician involvement, and evaluation methods.

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Section: Discussionmentioning

confidence: 99%

Toward Alleviating Clinician Documentation Burden: A Scoping Review of Burden Reduction Efforts

Sloss,

Abdul,

Aboagyewah

et al. 2024

Appl Clin Inform

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show abstract

“…This functionality allows updates to be made without requiring creation of a new document, while maintaining old documents for medicolegal purposes. Multiple such systems have been described and implemented in medical contexts, described as dynamic documentation or the wiki model, but have not yet been widely implemented.…”

Section: Discussionmentioning

confidence: 99%

Prevalence and Sources of Duplicate Information in the Electronic Medical Record

Steinkamp

Kantrowitz²,

Airan-Javia

2022

JAMA Netw Open

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ImportanceDuplicated text is a well-documented hazard in electronic medical records (EMRs), leading to wasted clinician time, medical error, and burnout. This study hypothesizes that text duplication is prevalent and increases with time and EMR size and that duplicate information is shared across authors.ObjectiveTo examine the prevalence and scope of duplication behavior in clinical notes from a large academic health system and the factors associated with duplication.Design, Setting, and ParticipantsThis retrospective, cross-sectional analysis of note length and content duplication rates used a set of 10 adjacent word tokens (ie, a 10-gram) sliding-window approach to identify spans of text duplicated exactly from earlier notes in a patient’s record for all inpatient and outpatient notes written within the University of Pennsylvania Health System from January 1, 2015, through December 31, 2020. Text duplicated from a different author vs text duplicated from the same author was quantified. Furthermore, novel text and duplicated text per author for various note types and author types, as well as per patient record by number of notes in the record, were quantified. Information scatter, another documentation hazard, was defined as the inverse of novel text per note, and the association between information duplication and information scatter was graphed. Data analysis was performed from January to March 2022.Main Outcomes and MeasuresTotal, novel, and duplicate text by note type and note author were determined, as were the mean intra-author and inter-author duplication per note by type and author.ResultsThere were a total of 104 456 653 notes for 1 960 689 unique patients consisting of 32 991 489 889 words; 50.1% of the total text in the record (16 523 851 210 words) was duplicated from prior text written about the same patient. The duplication fraction increased year-over-year, from 33.0% for notes written in 2015 to 54.2% for notes written in 2020. Of the text duplicated, 54.1% came from text written by the same author, whereas 45.9% was duplicated from a different author. Records with more notes had more total duplicate text, approaching 60%. Note types with high information scatter tended to have low information overload, and vice versa, suggesting a trade-off between these 2 hazards under the current documentation paradigm.Conclusions and RelevanceDuplicate text casts doubt on the veracity of all information in the medical record, making it difficult to find and verify information in day-to-day clinical work. The findings of this cross-sectional study suggest that text duplication is a systemic hazard, requiring systemic interventions to fix, and simple solutions such as banning copy-paste may have unintended consequences, such as worsening information scatter. The note paradigm should be further examined as a major cause of duplication and scatter, and alternative paradigms should be evaluated.

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“…For example, wiki-based documentation systems support collaborative, iterative problem-based care planning, while still meeting the need for a "snap-shot" for the EHR progress note. 22 Leveraging current technology capabilities can enable one care plan to be structured, tagged, and then repurposed for multiple different scenarios (e.g., daily note, handoff, to-do list, off-service note, discharge summary) without requiring any duplicative documentation. 2 For example, follow-ups for the nocturnist can be tagged and completed within the daily progress note, while open items can be sorted into a list of "to dos.…”

Section: Rebuttal Subha Airan-javia and Adam Rodmanmentioning

confidence: 99%

“…There already exist technologies to streamline many of these processes. For example, wiki‐based documentation systems support collaborative, iterative problem‐based care planning, while still meeting the need for a “snap‐shot” for the EHR progress note 22 . Leveraging current technology capabilities can enable one care plan to be structured, tagged, and then repurposed for multiple different scenarios (e.g., daily note, handoff, to‐do list, off‐service note, discharge summary) without requiring any duplicative documentation 2 .…”

Section: Rebuttalmentioning

confidence: 99%

Point‐counterpoint: Time to wash away the SOAP note—Or merely rinse it?

Rodman,

Schaye,

Hofmann

et al. 2023

Journal of Hospital Medicine

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A Mobile, Electronic Health Record-Connected Application for Managing Team Workflows in Inpatient Care

Cited by 7 publications

References 44 publications

Toward Alleviating Clinician Documentation Burden: A Scoping Review of Burden Reduction Efforts

Toward Alleviating Clinician Documentation Burden: A Scoping Review of Burden Reduction Efforts

Prevalence and Sources of Duplicate Information in the Electronic Medical Record

Point‐counterpoint: Time to wash away the SOAP note—Or merely rinse it?

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