The improvement of clinical documentation has always been a major focus for value-based care initiatives of many health systems. However, obtaining more efficient and accurate charting, especially for physicians or therapists using legacy electronic health record (EHR) systems is a strenuous task with no reliable template.
Recently, the Mayo Clinic College of Medicine carried out a project on EHR documentation. The Department of Physical Medicine and Rehabilitation utilized lean processes for redesigning an inefficient, EHR documentation system; the project was a success.
According to the Mayo Clinic experts, the execution of Lean methodology proved to be an effective way of reducing time spent by therapists on EHR documentation, improving therapist productivity, and also increasing the satisfaction of internal and external stakeholders.
The researchers realized that using the lean processes, the time reduced were from 2.8 hours to 1.9 hours per day for a therapist and it helped in increasing the time spent on patient care from 53 percent to 71 percent.
However, the lean methodologies have been used in the industrial sector for several decades, but now are being increasingly adopted in healthcare for driving quality improvement to reduce or eliminate delays, errors, and redundancy.
After identifying the existing EHR limitations in a documentation system designed for patient's physical therapists and occupational therapists, the Mayo Clinic experts with a lean six sigma approach were able to define, analyze, measure, control, and improve the framework. The major problem discovered by rehabilitation therapists while utilizing the original EHR was dependence on a poorly designed documentation template categorized by tremendous volume and redundancy of information. Such information often resulted in a lengthy and ambiguous text rendition.
Physicians, rehabilitation therapists, and other providers often describe identifying the important aspects of the patient evaluation or treatment to be challenging. Regardless of the fact that the EHR system was custom-built for Mayo's Department of Physical Medicine and Rehabilitation, the physicians, rehabilitation therapists, and other providers were not included in the initial planning phases or given an opportunity to provide feedback on the template design or content.