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Understanding EHR Documentation Assistants, Voice Assistants

Health systems across the country are integrating EHR documentation assistants to boost EHR documentation and mitigate clinician burnout.

EHR documentation was originally devised to record clinical information as provider notes in real-time during a consultation, evaluation, imaging, or treatment, ultimately to share patient data between providers.

Although the shift from paper to digital EHR documentation produced useful and legible notes, it is a primary cause of clinician burden, due to information overload and more extensive amounts of text that are not always relevant to patient care.

Extensive EHR use and documentation pressure can lead clinicians to carve out a strict weekly routine.

“Certain times during the evenings or on the weekends, I make sure I spend a couple of hours prepping for the week to make sure my inbox is cleared out, all my refills are done, all my results are reviewed, patient charts are completed prior to their office visit, and ensuring I get my notes done within 24 to 48 hours,” Neesha Patel, MD, Cooper University Healthcare, said in an interview with EHRIntelligence.

“I constantly planned documentation into my day in case I'm not able to get it done during clinic, because I often have medical students too,” continued Patel, who also doubles as an assistant professor at Cooper Medical School of Rowan University. “So that's a balance, because I do love to teach, so I want to make sure I'm teaching and [students] are not sitting there watching me document because that's not useful to their learning.”

EHR documentation helps providers share patient information among healthcare providers. However, the practice has its shortcomings.

According to an American Medical Association study, the clinician burnout rate is roughly 44 percent, much higher than burnout rates in other professions and as noted, most healthcare professionals say EHR use is the main cause.

“EHR documentation is probably the single greatest burnout issue for our clinicians,” BJ Moore, CIO and executive vice president of Providence said in an interview with EHRIntelligence. “We've done everything, including hire scribes to help with that process. It's something doctors just worked through, and that, unfortunately, adds to their burnout.”

Therefore, healthcare organizations target and integrate EHR documentation assistants to ease clinician burnout and streamline documentation.

EHR Documentation Assistants Are Mitigating Clinician Burnout

EHR documentation methods are evolving to meet clinician needs. An EHR scribe tool is a recently developed documentation tool aimed at alleviating burden and reducing the use of a human scribe.

To mitigate workflow demands, Patel adopted and integrated an EHR scribe solution, called TrekIT, into the EHR. 

“I started using that to document and the workflow has been much simpler because I’m not planning my day around when I’m going to get my documentation done,” Patel said. “Documentation is now a side note for me. The volume increased with COVID-19 for the number of patients we had to see, so I wasn’t able to see all of my expected patients per day.”

With the clinical workflow tool, Patel could treat her total volume of patients per day, which she said is not typical at a long-term care facility.

“I could see twice the daily volume,” Patel said. “I'm not going to say it was a time-saver. It was more that it allowed me to invest my time elsewhere by having an effective way to document. And by investing time elsewhere, I can talk to families who weren't able to come in and visit their loved ones, which was challenging.”

That meant Patel and her team could also invest time talking to nurses’ aides and assistants to see if there are any subtle changes with the patient.

“Now I can keep attention with clinicians in rehabilitation to see if patients were declining because patients weren’t allowed to leave their rooms due to social distancing and keeping patients isolated,” Patel noted.

Moving from paper charting to documentation, especially with an assistant, has helped because it kept clinician notes in one clean workflow, Patel said.

A similar integration occurred at OrthoIndy Hospital, one of the largest orthopedics specialty hospitals in the country. Clinicians were spending upwards of three hours after work to complete EHR documentation tasks.

“That is something that is a huge thing, that can lead to the loss of quality time with yourself, your family, and increased burnout rate,” Timothy Dicke, MD, president and CEO of OrthoIndy, said in an interview with EHRIntelligence. “It's been one of those burdens, which is part of that process.”

As a response, Dicke and health IT leaders at OrthoIndy integrated a mobile AI assistant, called Kara, to aid EHR documentation and restore a sense of work-life balance for its users.

“Kara was not our first attempt of trying to simplify this equation,” Dicke noted. “We have had success, and we have had movement of trying to ease the burden. I think many providers have tried different types of voice recognition versus scribes, versus other programs.”

While some EHR-implemented dictation tools can put notes into the incorrect place, Dicke said this well-designed tool is easy to implement, and the notes are documented in a clean, easy-to-read interface in the EHR.

“It has that ability of separating the different parts of note structure,” Dicke stated. “You can also use it beyond just the transcription, while adding it to the thought pattern.”

Almost immediately, Dicke and OrthoIndy clinicians saw the solution as a time-saver. Documentation was now occurring in real-time, instead of waiting an hour or two to document the visit. While many EHR-implemented tools come with a steep learning curve, that was not the case at OrthoIndy.

The Case For and Against Human Scribes

Hospitals utilize human scribes to aid clinicians with documentation to alleviate clinician burnout. These assistants intend to give clinicians more time away from the EHR or allow clinicians to complete out-of-visit tasks. However, issues can still occur.

Hiring an EHR documentation scribe does not improve the time for a clinician to complete out-of-visit tasks, such as answer patient portal messages, fill prescription requests, and send test results, according to a 2021 study.

The researchers analyzed scribed primary care providers and non-scribed PCPs for the time taken for clinicians to address patient portal messages, fill prescription requests, and send test results.

The researchers observed 472,411 tasks. These ranged from 27,645 tasks for five scribed PCPs and 444,766 tasks for 74 non-scribed PCPs.

The results showed that hospitals are increasingly integrating speech recognition tools into EHR systems to enhance clinical efficiency, improve EHR usability, and limit burden, considering scribes don’t help as much with non-patient-facing tasks.

Although a well-designed EHR scribe eases clinician burnout, developers are facing issues that make it tough to completely abolish the use of a human scribe, according to a study published in the Journal of Informatics in Health and Biomedicine.

According to the study, the number of medical scribes employed by US hospitals and facilities has been doubling annually since 2014. Research has shown that this number could reach 100,000 by the end of 2021. 

Due to the high cost of hiring human scribes, researchers aimed to develop a better understanding of their work in order to improve or optimize the design of speech-based scribe technology. What does a human scribe’s job look like, and how can that enhance the development of a digital scribe?

In a literature review of 65 studies that described how scribes were trained, certified, or evaluated, the researchers concluded that although digital scribes are helpful, there are certain functions that simply need to be done by a person.

“We found that there is significant variation in scribe expectations and responsibilities across healthcare organizations; scribes also frequently adapt their work based on the provider’s style and preferences,” wrote the authors of the study.

“Further, scribes’ job extends far beyond capturing conversation in the exam room; they also actively interact with patients and the care team and integrate data from other sources such as prior charts and lab test results.”

Research revealed that human scribes are able to adapt to the process of training, certifying, and managing medical scribes. It also showed that some health systems may have different documentation styles or expectations that cannot be followed by a digital scribe.

Second, digital scribes are not capable of interacting with the provider, other members of the care team, and patients. Because the digital scribe cannot be more than a silent transcriptionist, a health system may have to hire an assistant to fulfill the other tasks of the human scribe.

Health system leaders are listening to their clinicians for ways to enhance EHR documentation and mitigate clinician burnout. 

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