The Impact of Outpatient Documentation Standardization on Internal Medicine Resident Efficiency and Well-Being.

BACKGROUND

Documentation in the electronic health record (EHR) is frequently cited as a primary reason for burnout among physicians.

OBJECTIVE

To determine if standardization of documentation in the outpatient setting improved resident EHR efficiency and well-being.

DESIGN

Pre-post difference-in-differences evaluation of EHR efficiency metrics comparing intervention residents with a historical control group; pre-post survey on well-being for intervention residents.

PARTICIPANTS

Fifty-two post-graduate year (PGY) 2 and 55 PGY3 internal medicine residents compared with 55 PGY2 and 49 PGY3 historical controls at an urban academic clinic.

INTERVENTION: Standardized documentation templates and medication ordering practices and mandatory training on their use, with incentivized opportunities to practice documentation methods.

MAIN MEASURES: Time spent per appointment in chart review, note writing, and placing orders; length of notes measured in characters; number of characters of text copied from prior notes and pasted into the current note (copy/paste text); Mini-Z well-being survey assessed pre- and post-intervention implementation aggregated for PGY2 and PGY3 residents.

KEY

RESULTS

The intervention was associated with an 18.8-min and 12.0-min decrease in per-encounter documentation time for residents during their PGY2 year (p < 0.0001) and PGY3 year, respectively (p < 0.0001). Standardization was associated with a decrease in note length of 3650 characters (43.3%) for PGY2 residents (p < 0.0001) and 1608 characters (17.7%) for PGY3 residents (p < 0.0001), as well as a 66.7% and 74.6% decrease in copy/paste text for PGY2 (p < 0.0001) and PGY3 (p < 0.0001) residents, respectively. Among clinic residents completing pre (N = 42) and post (N = 28) surveys, there were no significant changes in Mini-Z scores, though the single item question on burnout improved from 3.2 pre-intervention to 3.7 post-intervention (p = 0.01).

CONCLUSIONS

Documentation standardization was associated with significant decreases in documentation time per visit, note length, and percentage of copy-paste text among PGY2 and PGY3 resident physicians. No change was detected on well-being metrics; however, analysis was limited by low response rate to well-being questions.