As clinicians transition to EHRs, changes are taking place in terms of the fundamental ways in which clinical information is documented. At the core of this transition to Computerized Provider Documentation (CPD) is the tension between the clinician’s behaviors when using a paper record (habits, reminders, and cues) and the very structured way that information is ideally recorded in an EHR. In a January 2012 study published in JAMIA titled “Computerized provider documentation: findings and implications of a multisite study of clinicians and administrators,” the authors examined computerized provider documentation through 14 focus groups conducted at five Department of Veterans Affairs facilities. Their conclusion: “CDP has dramatically changed documentation processes, impacting clinical understanding, decision-making, and communication across multiple groups.” In addition, they state, “Current CPD systems, while better than paper overall, often do not meet the needs of users, partly because they are based on an outdated ‘paper-chart’ paradigm.”
Recent data collected by AmericanEHR Partners, in which we analyzed 4,300 EHR satisfaction surveys conducted with users of certified EHR systems between 2010–2012 provides further insight into the behavior of physicians with respect to documentation of progress notes. A total of 71% of survey respondents were in practices of 10 physicians or less with 58% respondents who had used EHRs for three years or more. We will be presenting our findings in detail at HIMSS13 in New Orleans.
In answer to the question: “How Easy or Difficult is it to Document a Progress Note for Each Encounter?”, we examined satisfaction levels with the basic ability to document clinical progress notes using an EHR. Our findings demonstrate a progressive decrease in satisfaction levels across 80+ certified EHR systems from 2010–2012. (see graph below)
Ease or Difficulty in Documenting a Progress Note by Year
A potential explanation for the increased difficulty in documenting a progress note in 2012 vs. 2010 is that we are looking at a different population of physicians surveyed in each of the three years. In particular, a greater number of recent adopters of EHRs in 2012 as a result of the MU incentive program. However, our analysis does not support this finding. The average length of use prior to completing an EHR satisfaction survey in 2010, 2011, and 2012 is slightly below four years in 2010 and 2012, and slightly greater than four years in 2011. This finding suggests that the reduction in satisfaction in 2012 is more related to longer-term users of EHRs who have moved into the dissatisfied (or difficult) categories vs. recent adopters.
Geographic region did not appear to have any influence on these findings; however, satisfaction did vary depending on Practice Type. In private ambulatory care practices, 74% of physicians reported that documentation of a progress note was easy, similar to 72% of physicians in a federal government hospital (e.g. Military or VA). This contrasted with 55% of physicians in hospital owned ambulatory practices and 56% in academic medical centers who found documentation of a progress note to be easy. Potential explanations include differences in length of training or in the complexity of the EHR systems used in these settings or variations in the configuration of the systems.
A correlation does appear to be present between length of use of an EHR and ease in documentation of a progress note. As noted in the graph below, 76% of physicians who had used an EHR for five years or more found documentation of a progress note to be easy — significantly greater than the 53% of physicians who had used an EHR for six months or less.
Ease or Difficulty in Documenting a Progress Note by Length of Use of an EHR
The data presented above is a small sample of the total information collected through the AmericanEHR satisfaction surveys. As we further analyze the data, we will share our findings and look forward to your thoughts, questions, and comments.