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

OBJECTIVE: We analyze observed reductions in physician note length and documentation time, 2 contributors to electronic health record (EHR) burden and burnout. MATERIALS AND METHODS: 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. RESULTS: 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%). DISCUSSION: Organizations must consider priorities and tradeoffs in the distinct approaches needed to address different contributors to EHR burden. CONCLUSION: Future research should explore scalable burden-reduction initiatives responsive to both note bloat and documentation time.