Can We Please Stop Pushing the Paperwork Rock Uphill?

Derick Alison
Derick Alison
8 Min Read

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    Fred Pelzman is an associate professor of medicine at Weill Cornell, and has been a practicing internist for nearly 30 years. He is medical director of Weill Cornell Internal Medicine Associates.

Maybe if we sweat the little stuff, it will create the space we need to get the big stuff done.

In our practice, the level of frustration dealing with the day-to-day minutiae of outpatient primary care seems overwhelming, insurmountable. And we are a self-selected group of clinician educators, dedicated to working in an under-resourced practice serving an underserved community, all striving to make a difference and inspire the next generation of primary care doctors.

All day long, our faculty, nurse practitioners, and residents are bombarded with the little things — the endless paperwork, the forms that need to be signed, faxed and re-faxed, messages from insurance companies about prior authorizations, denials for imaging we requested, and endless messages in the patient portal, voicemail, and chats. So much stuff that needs getting done. It seems that it’s preventing us from practicing clinical medicine, and from innovating and improving the big things that matter.

The Burnout Continues

Since the pandemic, the level of burnout in healthcare workers has emerged and persisted, and the depth of healthcare inequities in this country has been further exposed, but even so we’ve tried to recover, revitalize, and reinvigorate how we practice medicine. Still, everyone seems pretty exhausted.

Throughout the course of the weeks, months, and years, whenever we come up with a new idea, an innovation, a practice improvement project, a population health initiative, or another way to make things better for our patients and our providers, it seems that no one has the energy to move things forward. People are battling against the Sisyphean challenges of chart documentation for every encounter, in-basket bloat, and an endless flurry of papers. How can we get ourselves to care about the big things, when we’re so stressed, overwhelmed, and frazzled from taking care of the little things?

We came into this life, this job, this career, this calling, this desire to practice medicine and connect to our patients, to listen to them and help them move their health forward, to always be there for them. But over and over I’m hearing from colleagues, and seeing in the national press, how everyone seems to be at a breaking point — short-fused and short-tempered. So maybe if we make the little things easier, we’ll have the bandwidth we need to tackle the bigger problems.

An eFax Failure

Take, for instance, a recent functionality that was turned on within our electronic health record: a system for efaxing. Apparently, we are getting rid of many of the large bulky fax machines in our practice, and the fax lines will now get fed directly into the medical record, routed into the correct patient’s chart (hopefully), alerting the primary care provider that they are there.

Unfortunately, they haven’t turned on the functionality to allow us to fill out these efaxes within the system. So now I get a message that I’ve received a form that needs to be completed for a patient, and what do I have to do? Print it out, fill it out by hand, then give it to somebody at the front desk to scan back into the chart again. This wastes time and human resources, creates opportunity for more errors, and certainly continues to waste paper.

We discovered that the functionality is there for me to fill it out online and sign it, but they just didn’t turn this on. Maybe someone decided not to pay for this part of the program.

Wouldn’t it be great if this thing was smart enough to pull all the relevant clinical information right from the electronic health record (EHR) such as past medical history, medication lists, allergies, and recent labs or imaging, preventing all the potential errors from me copying this stuff back onto a form by hand?

These days it feels like most industries are doing all of this stuff online, filling out and electronically signing forms, whisking them back and forth through the ether, without a lot of problems. Why can’t we do the same?

Look at the process for scheduling Medicare Annual Wellness visits at our practice. We built a visit type in the EHR specifically for this visit, that pushes the necessary Annual Health Review form for patients to be able to fill out in advance of their appointment. But over and over our schedulers are putting patients in as Routine Follow Up visits, even when the notes they type in say that the patient has Medicare and is coming in for their annual. Those are lost opportunities for needed care, not to mention huge lost income opportunities for the practice.

Many Openings for Improvement

There so many opportunities for stuff to be streamlined, alleviating the headaches of these mundane tasks that fill our days, but somehow, no one seems interested in making our lives better. Wouldn’t it be terrific if we had a system where every healthcare form, every durable medical equipment prescription, every letter to a patient, every transportation and home care form, and every screening questionnaire our patients needed filled out was handled effortlessly? Think how much time and energy we’d have left over at the end of the day.

What if we commit to a truly paperless office, with truly smart systems that help everybody get the right work done at the right time? Maybe we could bring in some experts on workflow management and time management (or just ask us, the end users, how to make it work), and build a system that’s worthy of a healthcare system in the 21st century. Maybe then we wouldn’t all be coming home and doing endless in-basket chores and completing patient charts in our pajamas, something that makes healthcare seem so transactional today.

Someone sent me a meme entitled “Sisyphus when he’s allowed to work from home”; it showed a huge boulder just sitting in the corner of someone’s living room. If we gave the boulder a rest, maybe then we’d have the energy, the heart, the soul, the love, and the drive to dedicate ourselves to fixing the bigger things, the things that matter. Instead of perpetually pushing that rock uphill, we could hammer away at what’s really in the way.

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