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Strategies for EHR Documentation During Telehealth Visits

EHR telehealth integration is critical for enhanced EHR documentation, but other options could streamline the process.

Telehealth has become a widespread option for patient care. But with clinician burden — primarily due to excessive EHR use — quickly swelling, health IT experts are looking for ways to streamline EHR documentation.

When clinicians record patient information as provider notes in real-time during a patient encounter, EHR documentation helps clinicians share patient data among health providers.

However, the practice has its drawbacks.

“EHR documentation is probably the single greatest burnout issue for our clinicians,” BJ Moore, CIO and executive vice president of Providence, said in a previous 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.”

According to the American Medical Association, the clinician burnout rate is roughly 44 percent, which is much higher than burnout rates in other professions.

Meanwhile, telehealth visits spiked in 2020 during the height of COVID-19, which forced providers across the country to optimize their respective EHR documentation processes. EHR documentation could be a massive burnout issue, not to mention the imperative to also make a connection with patients through a screen.

EHR Telehealth Integration

Integrating a telehealth platform into the EHR and patient portal can reduce clinician burden and ease documentation. And when patients have convenient access to telehealth, it can reduce travel for patients and enhance patient flexibility.

“It's opened up a great opportunity to be more consumer-centric, to understand the kind of inconvenience and difficulty that even coming to the clinic sometimes brings to families,” David West, MD, medical director of health informatics at Nemours Children's Health, explained in a previous interview.

An EHR-integrated solution does not require multiple clicks to bounce between documentation and video screens, West said. Thus, this decreases cognitive workflow and reduces clinician burden.

“If you can deliver the value that's necessary for that child's care without necessarily making them disrupt or having them disrupt their lives less, that is a good outcome and certainly creates better engagement with patients and physicians,” continued West.

“It means more when the physician says, ‘You do need to come in’ there's now more significance to that statement about what type of data one has to gather to appropriately care for that child.”

Furthermore, EHR integration automates data entry and eliminates the need to enter the same patient information more than once.

After the telehealth visit is over, the clinician can create a summary of the visit. Without integration, the clinician must enter the same information into the EHR and the disparate telehealth solution.

Telehealth quickly evolved to become a more traditional clinical experience, except it occurs from the patient’s couch, home, or work. For example, a patient can also schedule a future appointment with a front desk employee by staying on the video chat after completing the visit.

“When you document a telehealth visit, there are some unique documentation requirements that come into play, like where is the patient? That's never anything you have to answer when they're face-to-face with them, but you have to determine, are they at home? Well, they put that kind of documentation in the visit,” West said.

And because the telehealth solution was integrated on the same EHR platform, Salim Saiyed, chief medical informatics officer at UPMC Pinnacle, said it made documentation very easy for users at his organization.

“The user is still within the same EHR because there is a floating window of the video,” Saiyed explained in an interview with EHRIntelligence. “The user can continue to document with the window open and he can toggle the floating window wherever he would like to place it. If they prefer, users can also utilize their iPhone for the video off to the side, while they document on the computer. Either way, it’s very convenient.”

Utilizing a Second Screen

Although telehealth integration is becoming more prevalent across providers, it is not available everywhere.

As a result, Ku-Lang Chang, MD, University of Florida Health, recommended adding a second screen, whether it is a laptop or tablet, to boost documentation.

“Use the primary screen for the telehealth camera and the electronic health record (EHR), and use the second screen for viewing the patient in real time,” Chang explained. “With the camera and the EHR on the same screen, you will be able to look at the EHR while doing documentation and then move your eyes just a little when you want to look into the camera and talk to the patient.”

Chang also suggested splitting the computer screen into two windows if a second screen is unavailable. Either way, it is a simple workaround for those leveraging an outside telehealth solution. 

Speech Recognition Technology

Voice recognition technology has helped healthcare organizations also overcome the time hurdles associated with EHR documentation.

At Cooper University Healthcare and Abagail House for Nursing and Rehabilitation, EHR documentation was one of the most pressing EHR issues.

“The amount of charting for notes takes a lot of time,” Neesha Patel, MD, at Cooper University Healthcare and Abagail House for Nursing and Rehabilitation, said in an interview with EHRIntelligence. “I would spend a lot of time outside of work and trying to coordinate what I do during the weekdays.”

But when the nursing home had an influx of patients during COVID-19, those documentation obligations became nearly impossible. Patel and her team adopted an EHR scribe solution to mitigate the workflow demands.

“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 telehealth visits expected to remain a popular option among patients and providers, EHR documentation optimization for telehealth will continue to transpire.

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