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Design and Participants: This national longitudinal cohort study using physician-week EHR metadata (2020-2021) investigated how EHR documentation time and visit volume change following the adoption of team-based documentation support (defined as new onset and consistent use of coauthored documentation with another clinical team member). A two-way fixed-effects difference-in-differences regression approach analyzed changes in weekly visit volume, EHR documentation time, total EHR time, and EHR time outside clinic hours, after team-based documentation support adoption. Event study regression models examined variation in changes over time and stratified models analyzed the moderating role of support intensity.
Results: In total,1,024 ambulatory physicians adopted support, 17,241 comparison physicians did not. The sample included 57% primary care physicians, 32% medical specialists, and 11% surgical specialists; 40% were in academic settings and 18% in outpatient safety-net settings. For adopters, visit volume increased 6.0% (2.5 visits/wk [95% CI=1.9-3.0]), documentation time decreased 9.1% (23 min/wk [−30 to −16]), overall EHR time decreased 4.1% (29 min/wk [−39 to −19]), and active EHR time outside clinic hours decreased 5.1% (−6.5 min/wk [−10 to −3.0]). Following a 20-week postadoption learning period, visits per week increased 11% and documentation time decreased 16%. Only high-intensity adopters (>40% of note text authored by others) realized reductions in documentation time, both for the full postadoption period (−54 min/wk [−65 to −42]; 21% decrease) and following the learning period (−72 min/wk; 28% decrease). Low adopters saw no meaningful change in EHR time but realized a similar visit volume increase.
Commentary: Palliative care (PC) is not immune to the burdens of the EHR. This large multisite study suggests that team-based documentation increases efficiency and reduces documentation time. PC core concepts and delivery curiously position us to either struggle with adopting team-based documentation or easily change practice. In PC, communication is our primary tool; we use nuanced written and verbal language to effectively understand and share a family’s goals. A non-PC trained scribe is likely to diminish the effectiveness of our written communication with consulting teams. Conversely, PC teams are already high-functioning interdisciplinary units. If physician documentation could be effectively shared among this team, we might be well positioned to adopt team-based documentation. Studies are needed to examine team-based documentation in PC and how it affects efficiency and communication of nuanced topics.
Bottom Line: While team-based documentation support appears to increase clinician EHR efficiency, it remains unclear how it may be applicable to PC.
Reviewer: Ross W. Cleveland, MD, Dana-Farber Cancer Institute/Boston Children’s Hospital, Boston, MA
References:
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Source: Apathy NC, Holmgren AJ, Cross DA. Physician EHR time and visit volume following adoption of team-based documentation support. JAMA Intern Med. 2024;184(10):1212-1221. doi:10.1001/jamainternmed.2024.4123.
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