Dive Brief:
- The average length of clinical notes increased 8.1% from May 2020 to April 2023, according to a report published last week by Epic Research, the largest EHR provider and medical software vendor in the U.S.
- However, 40% of providers reduced their average note length and nearly 90% spent less time writing notes.
- The data showing increased note length comes more than two years after the CMS overhauled evaluation and management billing codes in an attempt to reduce “note bloat” and associated documentation burden on providers.
Dive Insight:
Clerical documentation burdens for physicians expanded during the past decade in part due to increased regulatory requirements and the corresponding proliferation of EHRs — one 2017 study found providers spend more than half their workday on documentation tasks.
In 2019, the CMS introduced changes to evaluation and management services reporting, including eliminating some elements for code selection and allowing physicians to choose whether their documentation is based on medical decision making or total time, which captures face-to-face and non face-to-face time spent caring for a patient.
Longer notes are associated with increased redundancies and can cause “information overload,” hindering clinicians’ ability to effectively utilize the patient record to direct care, according to a study published in JAMA last year. Documentation burden is also associated with increased provider burnout, a problem that’s taken center stage since burnout soared during the COVID-19 pandemic.
The Epic report evaluated 1.7 billion clinical notes written by outpatient providers from May 2020 to April 2023 to determine whether the CMS revisions, which went into effect in January 2021, led to reduced note length.
Though the Epic study found that, on average, providers spent 11.1% less time writing notes in 2023, average note length increased from 4,628 characters in 2020 to 5,002 characters. Paradoxically, the providers who composed the longest notes spent the least amount of time on documentation. Providers who averaged notes of 5,314.5 characters spent 5.7 minutes composing notes, while providers who averaged 3,601.2 characters spent 6.9 minutes.
Clinicians were more likely to compose longer notes at organizations that had increased their use of copy/paste functions and Epic-owned “SmartTools,” which allow clinicians to auto-populate fields in a patient record with links, text, phrases or lists found elsewhere in the patient’s chart. This finding is consistent with past studies which demonstrated SmartTools contribute to note bloat.
It is possible to reduce note length, researchers noted. Forty percent of providers decreased their average note length over the study period, and the providers that most significantly cut note length came from across multiple specialties.
