Customizing Health IT to Support Physician Workflow and Reduce Burden

“Documentation is one of the most time-consuming parts of a doctor's day, particularly in primary care. It's an area ripe for improvement."

An attending physician at the University of Washington Medical Center and Harborview Medical Center, Seattle, Thomas H. Payne, M.D., is acutely aware of the impact that electronic health records (EHRs) have on clinical practice.  While EHRs have great potential to improve patient care, they also present workflow challenges for physicians. That’s why Dr. Payne is using funding from AHRQ to better understand and address the problems associated with physician note-writing practices in EHRs.

Clinical notes provide a record of care, include provider assessments, and serve as a way to communicate pertinent information to the patient’s multidisciplinary team. These notes are increasingly created using EHR documentation tools and appear in electronic form. The transition from paper to electronic documentation yields many advantages, including making it possible for multiple people to access notes simultaneously, improved legibility, and the ability to more easily search notes.

However, electronic notes have weakness, including overuse of copy and paste and increased length due to the importation of data stored in other parts of the EHR. "Documentation is one of the most time-consuming parts of a doctor's day, particularly in primary care. It's an area ripe for improvement," said Dr. Payne.

Physicians have voiced strong concerns that writing notes in EHRs takes more time than using paper or dictation; a consequence is that progress notes may not be completed and available to other team members until long after the clinician-patient encounter.

In an AHRQ-funded project, Dr. Payne and his team developed and implemented a voice-generated enhanced electronic note system, or VGEENS, to translate clinical notes into usable, actionable information on the EHR. The system was designed to match the workflow of physicians when doing inpatient rounds in order to improve accuracy and timely availability of inpatient progress notes. While VGEENS remains a work in progress, technical enhancements and other refinements are expected to improve the speed and accuracy of creating and reading notes, which will improve patient care and reduce physician burden.

This work builds on Dr. Payne’s previous informatics research, which focused on the introduction of large-scale clinical computing systems into health care organizations and the use of clinical computing systems to measure and improve care quality.  

In one such AHRQ-funded project, Evaluating the Impact of an Ambulatory Computerized Prescriber Order Entry/Clinical Decision Support System on Outcomes, Dr. Payne worked with a group of researchers who implemented an e-prescribing system at The Everett Clinic, a Washington State medical group, and evaluated its impact on medication safety.

Through his AHRQ funding, Dr. Payne’s work in customizing EHRs to better support physician workflow and practice advances the integration of computing systems into the process of care.  It has the potential to reduce clinician burden, speed access to information for the care team, and improve the care provided to patients.  These are goals consistent with Dr. Payne’s position as an AHRQ researcher and as Board Chair of the American Medical Informatics Association (AMIA).

Principal Investigator: Thomas H. Payne, M.D.
Institution: University of Washington Medical Center
Grantee Since: 2004
Type of Grant: Various

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