Importance of Patient Care Notes in EHR usability

When Health Information Technology for Economic and Clinical Health (HITECH) Act was signed in 2009, Electronic Health Records were supposed to bring a collaborative working platform and ease the work levels of the physicians to lead to more cost-effective healthcare, but now EHRs have become the primary driver of physician burnout. According to research by Philip Kroth, MD, director of Biomedical Informatics Research at UNM, about 40 percent of physician stress and burnout can be directly correlated with EHRs. EHRs are causing physician burnout by turning physicians into unhappy data clerks.

A survey shows that the time set aside for medical record-keeping has doubled. Physicians now spend two minutes at the computer for every minute spent with patients, and the workdays have extended into the physicians’ homelives. According to a survey by JAMA Network Open, one of the reasons for the longer time required for record-keeping is that the EHR clinical progress notes have grown longer and more redundant, which has ultimately led to more clinical burnout. The research found that the median not length has increased by approximately 60.1 percent since 2009, with an increase of 10.9 percent for median note redundancy.

While the standard templates for clinical notes aim to bring in standardization, it may hinder the value of patient records, make the note-taking activity significantly complicated, and physicians will need to put in a more extended period for note-taking. Long or repetitive notes can further cloud important patient information and can lead to clinical and diagnostic errors.

So, what’s the solution? The solution is to use a customized adjustable template to help clinicians write shorter and higher-quality clinical notes. One of the key strategies would to be have shorter case notes to address EHR-related physician burnout. The notes should be intuitive enough to automatically import large data fields such as medication lists and help in reducing the clinical note-taking time by designing text prompts to encourage independent clinical input.

patient care notes

Here are some of the best practices for writing shorter case notes:

  • Use intuitive templates that auto-populate medications, vital signs, and simple exams.
  • Have customizable and adaptable templates for different types of exams.
  • Allowing pertinent data like testing, consultation, or procedures to be automatically attached with the notes.
  • Use free form notes to take notes as questions are being asked and utilize intelligent note-taking capabilities to autofill data from free form notes while inputting information into the EHR.

Elixir – Need of the hour

Elixir EHR is the ultimate solution to all the note-taking problems! Elixir practice management is a simple yet robust system that efficiently handles the note-taking process across multiple facilities and locations. It is built on Salesforce – which makes it entirely customizable. A few of the Elixir’s note-taking capabilities can be summarized as follows:

1. Create Customizable care notes and forms

Elixir helps in creating customizable note templates as per the needs of the facility. The template builder setup in Elixir gives the healthcare facility detailed and complete freedom to define different sections in the note and what kind of information is expected in each section. This screen also includes details about the attachment requirement and signature requirements.

2. Auto-text generation

One of the features of Elixir that is immensely helpful to decreasing physician burnout is intuitive auto-text generation. The auto-text generation enables the user to add detailed sentences in the notes with a button click. .

3. Autofill abilities

Elixir takes clinical notes a step further with its intuitive abilities that help to autofill the notes with relevant existing data like medications, vitals, etc. The data is also allowed to be auto-populated from the existing clinical notes or the current clinical medical note being worked upon.

4. Note Extraction

Tracking patient reimbursements or claims daily is a tedious task as it requires the care team to send a lot of patient documentation to the insurance company for verification. While the next-generation integration abilities of Elixir can help you connect the system to the insurance company’s system, still some providers who choose to take a different route to send the data manually to the insurance company can be helped by Elixir. Elixir enables you to extract the clinical notes in pdf format and save it onto your system. This helps the healthcare providers to send all the pertinent information to the insurance company easily.

5. Note attachments

Elixir enables better communication through the notes by enabling you to add attachments to your clinical notes. Not just that, Elixir’s next-generation abilities enable you to mark those attachments better to enhance the communication among the care team members.

6. Group notes

Group therapies are probably one of the most important aspects in behavioural health industry. So, Elixir enables you to create and attach group notes to the respective groups. It gives you the freedom to add individual notes and make a combined note for that individual.

7. E-Signature

Make your facility truly-paperless with Elixir’s e-signature capabilities. Elixir allows for notes to be e-signed by the patients or care team members using pre-saved signatures in the system or by connecting e-signature pad.

8. Approval Process

The user can define the approval process of the note, which means they can stipulate levels of approval required for a note, and the user or profile or role responsible for approval at each stage. Enhances communication abilities provides automatic reminders to the concerned users for approving the note.

9. Public Site Forms

Has Covid increased trouble for your note-taking due to delays in communication or miscommunication? No issues, Elixir enhances your remote note-taking abilities by allowing your patients to fill up the relevant details in the notes or forms at home. Elixir creates a URL for the note/form which can easily access by the patient and the data filled by the patient over the URL is auto-populated in EHR note/form.

10. Intuitive Reporting

Apart from the above aspects, Elixir’s golden thread model also applies to its note-taking abilities, making each and every field on the note reportable. This takes Elixir to the next level in clinical and business reporting. So, Elixir can definitely prove to be the most powerful note-taking tool for your healthcare staff.

Elixir Practice Management Suite is a comprehensive solution which consists of four modules which fit rightly into your healthcare business irrespective of your facility size and type. The Elixir Contact Center module helps in managing the entire facility census and the patient intake process while the Elixir EHR solution aims at delivering an end-to-end seamless patient care experience. The third module is Elixir Billing, and it effectively fetches data from any EHR platform to process medical claims and manages the entire revenue cycle. Elixir Patient Portal is the last module, and it provides an integrated experience for the patients.

Do fill out this contact form if you feel that Elixir will be an asset to your system.

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