— HC IT Consultant (@HCITConsultant) January 13, 2016
This tweet inspired me to talk about the problem of double documentation in an EHR. This is a massive problem for many organizations. Unfortunately, when you look at Many EHR workflows they do require double documentation. Sometimes this is thanks to regulations like meaningful use. Other times it’s medical billing requirements that necessitate double documentation. In other cases patient safety and quality of care requires something to be documented twice.
Of course, when I say that these things “necessitate” and “require” double documentation that might not be completely accurate. Medical billing, patient safety, and quality of care don’t require double documentation (with a few well known exceptions like verifying allergies). Instead, it’s the EHR workflow that requires something be documented twice in order for you to bill at the highest levels or in order for the EHR to later make the right information available to you at a later time as part of a patient safety or quality of care effort.
The reality is that many EHR workflows are constrained in a way that doctors and other medical staff our doing double work. If you’ve ever been in the doctors or nurses shoes, you know how irritating double entry can be in a work environment. On the other hand, purging the double work can be a great way to improve your employee’s work life.
Turns out that patients have the same problem. I don’t know how many thousands of people over the years have complained about having to fill out the same health forms over and over. Turns out that patients don’t like the double entry and more than the doctors and nurses.
This post also reminds me of my doctor friend who taught me about how the EMR perpetuates misinformation. When you start double entering something, that makes that issue twice as complex to track and update.
Personally, I’ve found two types of double documentation. The first is when poorly implemented processes require double documentation. If multiple departments within the same organization were communicating more effectively, then this wouldn’t happen. The fix to this problem is not easy, but can be solved if the right leader brings together the various departments to help everyone really understand and address the problem.
The second situation is where the EHR interface doesn’t allow a specific workflow and so the only way to satisfy your internal requirements is to double document. This is a much more challenging siuation to solve. The only solution I’ve found is to become deep partners with your EHR vendor so that you can effectively communicate the problem and convince them to add your requirement to their long list of EHR product enhancements. This can be even more effective if you’re connected to other customers of your EHR vendor and you can leverage them as a second voice for why the problem needs to be solved. No doubt there is power in numbers when influencing changes in an EHR.
If you’re dealing with the challenge of double documentation, what are you doing to combat it? What solutions are available to help make this less of an issue?