Health Information Management

News: Studies, anecdotal evidence cite burden of documentation as detriment to patient care

CDI Strategies, April 15, 2010

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Recent CDI-related headlines include concerns about the burden of paperwork on patient care and the cost of healthcare. And article authors cite a few recent surveys to back up such assertions.

For example, a study published in April in BMC Health Services Research found that "the total time for [physician] communication with patients and their relatives was 85 minutes per physician per day" which averaged out at a little more than four minutes per patient.
The study, conducted at the University Medical Center Freiburg, a 1,700-bed academic hospital in Germany, observed physician behavior for all its 34 wards across 15 different medical departments. In all, study organizers analyzed 374 working hours. Physicians' discussions with their colleagues took the most time, roughly 150 minutes on average, while documentation and administrative takes earned second place, taking up an average of 148 minutes a day. Interestingly, however, the physicians themselves thought they communicated with patients twice as long as the study findings suggested.
The study results may add credence to a New York Times Blog post written by Pauline W. Chen, MD. Chen pulls a snippet from Lemony Snicket, the children's book series — a snippet which chastises the children heroes for not knowing that paperwork is the most important product produced by a hospital.
Chen then discusses a Mayo Clinic study “Time Spent on Clinical Documentation: A Survey of Internal Medicine Residents and Program Directors” published in the February issue of the Archives of Internal Medicine. In the report, nearly 70% of residents claimed to spend upwards of four hours a day on tasks related to clinical documentation but only about 40% said they spend at least four hours a day interacting with patients.
Chen isn't the only physician lamenting documentation burdens. C. L. Gray, MD, president of Physicians for Reform, wrote in a Fox News Blog that overhead costs such as billing and administrative assistance “consumes 60% of the average physician’s collections... Trapped under mountains of paperwork and handcuffed to inefficient billing and collection systems, the average medical practice must hire four support staff for every working physician,” Gray wrote.
Editor’s Note: This article originally appeared on the ACDIS Blog. Other recent articles on the blog include:

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