Capitol Correspondence - 11.13.18

One Big Picture Thing: Initiative to Reducing Burdensome Paperwork in Health Systems

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We are sharing this article by the New England Journal of Medicine because ANCOR members have often shared with ANCOR staff how burdensome paperwork feeds into the DSP workforce crisis. We think this article could offer some interesting parallels from the hospital world, and food for thought for I/DD providers.

As written by Dr. Melinda Ashton:

“Although my health system, like most in the United States, cannot magically eliminate the documentation required for billing and regulatory compliance, my colleagues and I had reason to believe that there might be some documentation tasks that could be eliminated. Our EHR was adopted more than 10 years ago, and since then we have made a number of additions and changes to meet various identified needs. We decided to see whether we could reduce some of the unintended burden imposed by our EHR and launched a program called “Getting Rid of Stupid Stuff.” Starting in October 2017, we asked all employees to look at their daily documentation experience and nominate anything in the EHR that they thought was poorly designed, unnecessary, or just plain stupid. The first thought we shared as we kicked off this effort was, “Stupid is in the eye of the beholder. Everything that we might now call stupid was thought to be a good idea at some point.”

We thought we would probably receive nominations in three categories: documentation that was never meant to occur and would require little consideration to eliminate or fix; documentation that was needed but could be completed in a more efficient or effective way with newer tools or better understanding; and documentation that was required but for which clinicians did not understand the requirement or the tools available to them.


In the second category — documentation that could be completed more effectively — we identified a feature called the rounding row that had been added years ago when we were implementing hourly rounding by nurses and nurse aides. The intention was to allow us to monitor whether this rounding was actually occurring. We had observed that this requirement led to an exercise of rote clicking that didn’t always accurately capture the care provided. We removed the row and informed nurses that what we were interested in was their usual documentation of the care they provided to patients. We were surprised to find that making this single click consumed approximately 1700 nursing hours per month at our four hospitals (given the average number of clicks per month and the fact that each nurse or nursing assistant spent 24 seconds per click). [Emphasis added by ANCOR.]