EHR Usability: Charting During Appointments

Dr. Bassi provides insight into documenting and charting considerations for healthcare providers, health practices and hospital systems.  

I am a psychiatrist starting my own practice and am looking for an electronic health record system that would optimize my time charting during patient appointments. I have heard that physicians can spend up to three hours per day charting, which is roughly consistent with the
amount of time I spend each day too. I would like to be able to maximize my charting abilities the most I can, while still being present and attentive in the patient appointment. (Name Withheld)

You’re right. Charting is notoriously considered to be one of the root causes of physician burnout (and source). It makes good sense to put extra effort in up front when choosing an EHR system, knowing it have a big impact on your own mental health.

When deciding among the vast selection of EHR systems, ask yourself what device you will primarily use to chart? Will you be virtual or in person, and will you be using a desktop or tablet? Some clinicians prefer a templated approach where they can click on options and have the chart fill automatically, while others prefer a free text and/or dictation hybrid approach. Here are some features to keep in mind during an EHR demonstration:

1.Inputting Methods. If you are someone who likes to click on templated buttons/options, make sure that these templates are easy to customize if you want to adjust them in the future. For those who prefer a free text approach, think about use of white space around the layout to minimize scrolling, and eye movements (if virtual). And for those looking to dictate, make sure that your operating system can easily input into that text box.  

2.Ease of Chart Navigation. Think about the areas you are most commonly going to reference during an appointment. For a psychiatrist, this may be a patient’s prescription history, lab results, and prior notes.  

3.QuickText or SmartPhrases. These can dramatically reduce the amount of time needed to chart by assigning long passages to a shortcut phrase.  

4.Use of Screen Real Estate. Everyone has different preferences for what amount of information they would prefer to see on one screen. As we increase more text and buttons on a screen, it reduces the amount of clicking and navigation (a good thing) but at the expense of feeling too “busy” or overwhelming. One’s perception of this is heightened with unfamiliarity, so be cognizant of this during the demonstration because as you get more accustomed to the layout you may actually prefer to have more information on one screen.
 
For the majority of individuals, there may be a few main priorities that need to be met when choosing an EHR. Ideally, the platform would be customizable to be flexible enough to meet everyone’s needs. The reality is that EHR systems are here to stay, and we can either have them be a main contributor of burnout, or have them work to our advantage.