HCA 120 Module 3 The EHR From an Administrative View Example

More Than a Chart: The Electronic Health Record Seen From the Administrator's Desk

Student Name

Health Care Administration Program, Aspen University

HCA 120: Healthcare Information Systems

Instructor Name

Month Day, Year

More Than a Chart: The Electronic Health Record Seen From the Administrator's Desk

The electronic health record is usually described as a clinical tool, the place where providers write notes and order tests. For administrators, it is also a workflow system that routes tasks, a source of billing data, a legal record and a major cost. Seen from the manager's office of a composite family practice staffed by six clinicians, this paper examines who uses the record and for what, the workload it creates and the changes administrators can make. Hospitals adopted certified records far faster once federal incentive payments began (Adler-Milstein & Jha, 2017), and office practices followed, so nearly every administrator now inherits one.

What the Record Holds

The record holds each patient's problem list, medications, allergies, visit notes, orders, results, immunizations, scanned documents and messages. It also holds data administrators rely on: the diagnosis and procedure codes that feed claims, the time stamps that show when tasks were done and the audit trail that records who opened each chart. The practice treats the record as its legal medical record, so what is written there must be complete, accurate and protected.

Who Uses It

Nearly everyone in the practice uses the record, but for different tasks. The table shows the main users.

Connections to Other Systems

The record is connected to the practice management system, which sends appointments and receives charges; to laboratories, which send results; to pharmacies, which receive prescriptions; and to the regional health information exchange, which shares records with hospitals. Each connection saves manual work when it runs and creates a new failure point when it does not. The office manager keeps a list of interfaces and whom to call when one stops.

The Documentation Burden

The record has shifted a large amount of clerical work onto providers. Event logs from 142 Wisconsin family physicians, checked against direct observation, put their record use at 355 minutes a weekday, more than half of a workday that averaged 11.4 hours, and 86 of those minutes came after clinic closed; notes, orders, billing, coding and other clerical work filled 44.2% of the record time, and the inbox another 23.7% (Arndt et al., 2017). For administrators, this burden matters because it contributes to burnout and turnover, which are costly to a small practice.

Time With Patients

The same pattern appears in direct observation. Observers who followed ambulatory physicians in four specialties found that even inside the exam room, 37.0% of physician time went on the record and desk work and 52.9% facing the patient (Sinsky et al., 2016). Patients notice when a provider looks at the screen more than at them. Room layout, such as placing the screen so the patient can see it too, is one inexpensive change administrators can make.

Delegating Inbox Work

The inbox is where results, refill requests, patient messages and forms arrive. In the composite practice, every item went first to the physician, who then sent many to staff. The office manager worked with physicians to route routine refills for stable chronic medications to medical assistants under a written protocol, normal results to nurses for patient notification, and forms to the front desk for completion before physician signature. Physicians saw fewer items and signed off faster.

Templates and Their Limits

Templates speed documentation but can also produce long notes full of copied text that hides what happened at the visit. The practice reviewed its templates with the physicians, removed unused sections and set default text to blank rather than normal findings. Billing staff also benefit, since notes that clearly state the problems addressed and decisions made support accurate coding.

Release of Information

Requests for records come from patients, other providers, insurers, attorneys and government agencies. The front desk processes them through the record's release-of-information function, which tracks the request, the authorization and what was sent. Patients have a right to access their own records, and many now view notes and results through the portal. Staff must verify each requester's identity and authority before release.

Access and Audit

The record contains everything about a patient, so access must be limited by role. The office manager assigns each user a role with only the functions needed, removes access on the day someone leaves and reviews the audit log for unusual patterns, such as staff opening records of coworkers or family members. These controls protect patients and the practice.

What Administrators Can Change

Administrators cannot redesign the vendor's software, but they control much of how it is used: who does which tasks, which alerts are turned on, how templates are built, how staff are trained and how interfaces are monitored. The composite practice set up a monthly meeting of a physician, a medical assistant, a front desk lead and the office manager to review record problems and agree on changes. Small changes made regularly added up.

Measuring Burden Locally

Most record systems can produce event-log reports for each provider, showing time in notes, time in the inbox and time after hours. The office manager reviews these reports each quarter with the physicians, not to rank them but to find where delegation or template changes could help. When one physician's after-hours time fell by about half an hour a day after inbox delegation, the others asked for the same change.

Training New Users

New employees receive record training by role before their first day with patients, covering only the screens they will use, followed by a week with an experienced colleague. When the vendor releases an update, the office manager circulates a one-page summary of changes that affect daily work. Short, role-specific training reduces the workarounds that appear when staff are left to figure out the system alone.

Conclusion

From the administrator's desk, the electronic health record is a shared workspace, a data source for billing and a legal record. It has brought safety and access, but it has also moved clerical work onto providers, taking hours of their day. Administrators can reduce that burden by delegating inbox work, simplifying templates, arranging rooms and running a regular forum for record problems.

References

Adler-Milstein, J., & Jha, A. K. (2017). HITECH Act drove large gains in hospital electronic health record adoption. Health Affairs, 36(8), 1416-1422. https://doi.org/10.1377/hlthaff.2016.1651

Arndt, B. G., Beasley, J. W., Watkinson, M. D., Temte, J. L., Tuan, W.-J., Sinsky, C. A., & Gilchrist, V. J. (2017). Tethered to the EHR: Primary care physician workload assessment using EHR event log data and time-motion observations. Annals of Family Medicine, 15(5), 419-426. https://doi.org/10.1370/afm.2121

Sinsky, C., Colligan, L., Li, L., Prgomet, M., Reynolds, S., Goeders, L., Westbrook, J., Tutty, M., & Blike, G. (2016). Allocation of physician time in ambulatory practice: A time and motion study in 4 specialties. Annals of Internal Medicine, 165(11), 753-760. https://doi.org/10.7326/M16-0961