I had not time to make it shorter: an exploratory analysis of how physicians reduce note length and time in notes.

Abstract

We analyze observed reductions in physician note length and documentation time, 2 contributors to electronic health record (EHR) burden and burnout. We used EHR metadata from January to May, 2021 for 130 079 ambulatory physician Epic users. We identified cohorts of physicians who decreased note length and/or documentation time and analyzed changes in their note composition. 37 857 physicians decreased either note length (n = 15 647), time in notes (n = 15 417), or both (n = 6793). Note length decreases were primarily attributable to reductions in copy/paste text (average relative change of -18.9%) and templated text (-17.2%). Note time decreases were primarily attributable to reductions in manual text (-27.3%) and increases in note content from other care team members (+21.1%). Organizations must consider priorities and tradeoffs in the distinct approaches needed to address different contributors to EHR burden. Future research should explore scalable burden-reduction initiatives responsive to both note bloat and documentation time.