Hospitals have frequently turned to implementing electronic documentation systems in their emergency departments that were not specifically designed for the ED. Deployment of these systems has actually made the clinicians using them significantly less productive. ED physicians are spending less time seeing and treating their patients and more time in front of computer screens, working in electronic charting applications with poor user interfaces that are not designed for optimal workflow. The result is that departmental efficiency suffers in number of ways.
1) Significant loss in productivity. Experience has shown that the shift from paper charting and dictation to electronic documentation has resulted in a loss of productivity for a majority of physicians and hospitals. Physicians spend up to 30% of their shift time documenting patient encounters. Rigid chart design, poor functionality and the number of clicks is takes physicians to find key information like laboratory and radiology results has had the impact of doubling or tripling the time it takes physicians to document patient care.
2) Low Quality and Incomplete Charts Increase Hospital Liability. Poorly designed electronic physician documentation systems generally result in the physician completing his/her charts long after patients are admitted to the hospital or discharged from the ED. This leaves the Hospitalists and/or Primary Care Physicians without pertinent and timely information about care delivered and can also result in poor quality care and reduced patient satisfaction.
3) Higher CMS Hospital Scrutiny. Some electronic documentation systems promote overutilization of ordered tests and procedures, which could be perceived as encouraging inappropriate patient admissions bringing about significant attention and scrutiny by regulators such as CMS. This can also have drastic reimbursement impacts for 30 day re-admissions and value based purchasing. Creating flags and alerts to prompt physicians with options on how to treat each patient can help reduce unnecessary admissions. With FlexChart for example, clinical pathways are embedded into the physician workflow to better deliver patient care - eliminating 30-day readmission penalties and decrease value-based purchasing.
ED clinicians operate in a fast-paced and constantly changing environment with many stakeholders. The right solution must provide clinical awareness for physicians and enhance communication with other clinicians while allowing for speedy, high quality and complete documentation of patient visits by physicians, addressing head on the top challenges faced by them and their constituents.
Critical components of an optimal physician documentation solution in the ED include:
- Simplicity. Minimal number of clicks to find key data elements and intuitive documentation workflow.
- Usability. Intuitive solution that with non-intrusive options and guiding tools that don’t negatively impact the physician workflow.
- Speed. Allow for concurrent charting with minimized computing time which to allow for increased time at the patient's bedside (a major factor driving patient satisfaction).
The challenge is to find the right balance of the features listed above that will also support best practices and fiscal responsibility. Emergency department charting software - such as Forerun’s FlexChart - delivers optimal workflow for charting in the ED and provides the tools to build the chart in small, easily completed segments.
This functionality has the effect of converting the task of documenting patient encounters from one long, often interrupted undertaking into brief, easily completed discrete tasks often short enough to avoid interruption. By the time the data is being reviewed by the physician and the disposition of the patient is being made, the document is nearly complete. Concurrent care of the patient and documentation of the encounter maximizes the opportunity for electronic reminders, decision rules and cognitive aids to positively impact both documentation and the actual care delivered.
In addition to improving operational performance while fostering safe hand-offs and best in class continuity of care, Forerun is committed to providing tools and functionality that improve the quality of appropriate and fiscally responsible documentation, and to ensuring they do not support or encourage behavior that could lead to increased regulatory scrutiny for our customers, or abuse. You can download a data sheet, request a demonstration, or contact us to find out more.