Moving to More Evidence-Based Primary Care Encounters

Barry, Michael J.; Tseng, Chien-Wen

doi:10.1001/jama.2022.18346

Cited by 5 publications

(2 citation statements)

References 6 publications

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“…As early as the 1860s physicians noted that performing a complete symptom inventory was so time‐consuming as to make it impracticable. Studies stretching back 80 years have found that performing a comprehensive ROS takes an average of 15 min—time few clinicians have to spare 7,9,10 …”

Section: Rise Of the Rosmentioning

confidence: 99%

Reclaiming the review of systems: An opportunity for medical educators

Rodman

Dhaliwal

2023

Journal of Hospital Medicine

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Section: Rise Of the Rosmentioning

confidence: 99%

Reclaiming the review of systems: An opportunity for medical educators

Rodman

Dhaliwal

2023

Journal of Hospital Medicine

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“… We continue to document based on reimbursement and tradition rather than scientific evidence. In their essay subtitled “A farewell to the review of systems,” Barry and Tseng argue for deleting the traditional review of systems and that documentation should be based on scientific evidence ( 17 ). …”

Section: Why Are Our Notes So Bulky?mentioning

confidence: 99%

It’s time to change our documentation philosophy: writing better neurology notes without the burnout

Rodríguez-Fernández

Loeb

Hier

2022

Front. Digit. Health

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Succinct clinical documentation is vital to effective twenty-first-century healthcare. Recent changes in outpatient and inpatient evaluation and management (E/M) guidelines have allowed neurology practices to make changes that reduce the documentation burden and enhance clinical note usability. Despite favorable changes in E/M guidelines, some neurology practices have not moved quickly to change their documentation philosophy. We argue in favor of changes in the design, structure, and implementation of clinical notes that make them shorter yet still information-rich. A move from physician-centric to team documentation can reduce work for physicians. Changing the documentation philosophy from “bigger is better” to “short but sweet” can reduce the documentation burden, streamline the writing and reading of clinical notes, and enhance their utility for medical decision-making, patient education, medical education, and clinical research. We believe that these changes can favorably affect physician well-being without adversely affecting reimbursement.

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Physician EHR Time and Visit Volume Following Adoption of Team-Based Documentation Support

Apathy,

Holmgren,

Cross

2024

JAMA Intern Med

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ImportancePhysicians spend the plurality of active electronic health record (EHR) time on documentation. Excessive documentation limits time spent with patients and is associated with burnout. Organizations need effective strategies to reduce physician documentation burden; however, evidence on team-based documentation (eg, medical scribes) has been limited to small, single-institution studies lacking rigorous estimates of how documentation support changes EHR time and visit volume.ObjectivesTo analyze how EHR documentation time and visit volume change following the adoption of team-based documentation approaches.Design, Setting, and ParticipantsThis national longitudinal cohort study analyzed physician-week EHR metadata from September 2020 through April 2021. A 2-way fixed-effects difference-in-differences regression approach was used to analyze changes in the main outcomes after team-based documentation support adoption. Event study regression models were used to examine variation in changes over time and stratified models to analyze the moderating role of support intensity. The sample included US ambulatory physicians using the EHR. Data were analyzed between October 2022 and September 2023.ExposureTeam-based documentation support, defined as new onset and consistent use of coauthored documentation with another clinical team member.Main Outcomes and MeasuresThe main outcomes included weekly visit volume, EHR documentation time, total EHR time, and EHR time outside clinic hours.ResultsOf 18 265 physicians, 1024 physicians adopted team-based documentation support, with 17 241 comparison physicians who did not adopt such support. The sample included 57.2% primary care physicians, 31.6% medical specialists, and 11.2% surgical specialists; 40.0% practiced in academic settings and 18.4% in outpatient safety-net settings. For adopter physicians, visit volume increased by 6.0% (2.5 visits/wk [95% CI, 1.9-3.0]; P &lt; .001), and documentation time decreased by 9.1% (23.3 min/wk [95% CI, −30.3 to −16.2]; P &lt; .001). Following a 20-week postadoption learning period, visits per week increased by 10.8% and documentation time decreased by 16.2%. Only high-intensity adopters (&gt;40% of note text authored by others) realized reductions in documentation time, both for the full postadoption period (−53.9 min/wk [95% CI, −65.3 to −42.4]; 21.0% decrease; P &lt; .001) and following the learning period (−72.2 min/wk; 28.1% decrease). Low adopters saw no meaningful change in EHR time but realized a similar increase in visit volume.Conclusions and RelevanceIn this national longitudinal cohort study, physicians who adopted team-based documentation experienced increased visit volume and reduced documentation and EHR time, especially after a learning period.

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Moving to More Evidence-Based Primary Care Encounters

Cited by 5 publications

References 6 publications

Reclaiming the review of systems: An opportunity for medical educators

Reclaiming the review of systems: An opportunity for medical educators

It’s time to change our documentation philosophy: writing better neurology notes without the burnout

Physician EHR Time and Visit Volume Following Adoption of Team-Based Documentation Support

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