Charting Efficiency

Studies have shown that charting is the main cause of physician burnout. I was on of them. I remember wishing for a clinic day consisted of only seeing patients and with no or bare minimum of patient documentation. It was not just the charts. It was also the phone calls, the test results, the administrative tasks, and for the doctors who are in academia, many also had research responsibilities. A major problem was the time spent in charting.

As a hematologist and oncologist, if I were to see 30 patients with iron deficiency anemia, I would likely had no problem finishing my day in less than 8 hours. In reality, my patient population was and is a mixed variety, with both benign hematology and medical oncology. Some patients need more emotional support, others may need more discussion. In other words, the established patient encounter itself may vary from 5 minutes to 40 minutes.

Every patient is a human being. When patients do not present with the classic or textbook presentation, it is because they did not read the textbook. What I mean is, every person is unique. No two people with the same diagnosis behave the exact same way. This also means that each patient chart is different, with different contents to describe different clinical courses.

A very common complaint among physicians is that the electronic health record (EHR) they are using is suboptimal. Sometimes they may even say that the other company’s EHR is a better system. Sure, if we compare the EHRs from different companies side by side, some will have better features than others. No one EHR is perfect. This does not mean we cannot be more efficient in optimizing what is available in a particular EHR system. It is important to know your EHR system well. This means that the functions of each button, the shortcuts, the text expanders, etc. Take your time to learn your system well. If your job requires you to use more than one EHR system, know all of them well. Even if you have full utilization of a scribe, know the system well, for the just in case one day you have to do the documentation yourself, or you have to train a brand new scribe.

When to chart greatly impacts your efficiency. Chart as you go is the best way to save your time and energy. If you have a real-time scribe, that should not be a problem. If you are writing up the chart yourself, just like I do, it is best to have great typing skills. Practice makes perfect. If you do not believe you can type without looking at the keyboard, we can work on that belief. In the meantime, the dictation program is your friend. Dictate each patient’s note right after you finish each patient encounter. If you can pre-populate certain sections of the note, such as the past medical history, start the note with it. Copy forward is a time-saving function, and be careful not to blindly copy forward data without updating the pertinent information.

If you wait until the end of the day to finish the charts, you will likely take much longer to complete each chart than if you see the patient and do the chart, one at a time. At the end of the day, you are likely physically and mentally exhausted. The thought of having to stay extra hours to finish your work can feel frustrating and overwhelming. The thought of being “taken away” from your free time or your family time can be infuriating.

Allow yourself the discomfort of letting your patients wait a little longer so that you get to finish the previous patient’s chart. By having a complete patient encounter, with the patient seen, tests ordered, prescription sent and chart closed, you then can put your focus on the next patient.

The most important thing about efficient charting is your opinion about charting. As much as you may dislike doing patient documentation, it is something that has to be done – unless you are no longer in clinical medicine. Use helpful thoughts to focus your day. A helpful thought is thinking more positively, or at least in a neutral way. For example, thinking that you are capable of finishing up at a reasonable time with the charts done is a helpful thought. Helpful thoughts generate emotions which are more constructive and energizing. Those emotions are sustainable throughout the day. On the other hand, if you are thinking that there are too many patients to see and too many charts to write up, it is not helpful. The emotions generated from this sentence are likely overwhelm, stress or anger. Using these negative emotions as fuel is draining and exhausting.

Even if you are currently charting an extra 3 or more hours and it seems impossible to ever go home on time, let yourself be open to possibilities. Identify what the main issue with charting is for you. Work on it, a little at a time. It is possible to see the same number of patients as you are now and go home 2-3 hours sooner with all your work done. You may need some help from a mentor or a coach. I did it and so can you.