Clinicians Nationwide Share Best Practices to Reduce Note Length

Progress notes in the U.S. are three times the length of those in other countries and contribute to “pajama time,” where physicians are charting outside of work hours. In 2021, health systems have the opportunity to change this trend with new guidelines from the American Medical Association that change requirements so doctors have to include only information that’s clinically indicated and medically relevant. Epic’s physician well-being team and health systems across the U.S. are preparing for this change by working together to refocus notes toward their intended clinical purpose.

To help physicians take advantage of more focused notes, Epic’s physician well-being team equips each organization with a toolkit to change note-writing practices and guidelines. The toolkit includes strategies for adopting time-saving tools, recommendations for updating note templates, resources for clinician education, and instructions on using Epic’s provider efficiency tracking tool, called Signal, to measure improvement. The toolkit is the framework for projects kicking off at organizations including Sutter Health, Novant Health, and University of Wisconsin Health in early 2021.

“Epic’s project plan fills a gap in knowledge around tools that could support more efficient note creation and consumption,” said Benj Barsotti, MD, CMIO at Aspirus in Wausau, Wisconsin, and one of the clinical leaders working with Epic to share note-reducing best practices. “But there’s also insight into why people write notes the way they do. Recognizing those ingrained practices is key to making effective changes.”

In the spirit of sharing the best ideas for everyone to replicate, the toolkit builds on past successes from many Epic community members, including projects like these:

• UCLA Health, UCSF Health, UC San Diego, and University of Iowa Health Care developed an improved template designed to guide the clinical thought process. After they updated their teaching, notes were not only 25% shorter, but also signed sooner and rated as higher quality by attending physicians.
• Sanford Health updated specialists’ note templates and saw time writing notes during appointments drop by up to 42%.
• Rady Children’s Hospital and UC San Diego reduced the length of discharge summaries by 50% by removing extra text from their note templates.
• Hennepin focused on incorporating lists of frequently chosen options and educating clinicians on efficiency tips. They saw notes drop by an average of more than 1,500 characters among 45 clinicians.
• The University of Chicago reduced note length by up to 40% and improved note quality with new templates.
• The University of Vermont Medical Center redesigned their suggested note template to collapse information clinicians use infrequently and reduce scrolling. Two weeks after its introduction, 84% of progress notes used the new template.

“There’s never been a better time to make the kinds of big changes that we know will lead to shorter clinical notes and happier physicians,” said Sam Butler, MD, a physician leader on the physician well-being team at Epic. “This new guideline is a step in the right direction and we’re going to run with it.”

Read more about Sanford Health’s project from Healthcare IT News. Epic community members can get started planning their own projects and see detailed steps for U of Chicago’s and Rush’s programs on the UserWeb.