Healthcare · Clinical operations

Reducing clinical documentation time in an outpatient service

Clinicians completed documentation after clinic hours, with a median of 90 minutes per day spent outside scheduled time. Backlogged notes delayed coding and billing.

First Workflow Build

Company shape: Multi-site outpatient provider, 400 to 900 clinicians
Timebox: 10 weeks
Systems: EMR, Scheduling, Dictation

IllustrativeThis write-up is a composite drawn from work of this shape. It is labelled because presenting a composite as a single engagement would be a fabrication.

Before

The state we started from

Clinicians completed documentation after clinic hours, with a median of 90 minutes per day spent outside scheduled time. Backlogged notes delayed coding and billing.

The decision

What had to be decided first

The value map named documentation minutes per encounter, the Chief Medical Information Officer as owner, and a four-week within-clinician comparison as the validation method. Clinical governance required review before any note enters the record.

Built

What was actually built

A drafting workflow inside the EMR, inheriting its permissions, producing a structured draft that the clinician must edit and sign. No note enters the record unsigned. Every draft and edit is retained for audit.

What changed

Documentation time fell from a median of 11.4 minutes to 6.2 minutes per encounter

Measurement window: Four weeks, within-clinician comparison across 38 clinicians
Methodology: Measured from EMR timestamps, not self-report. Clinicians acted as their own control against their prior four-week median. Editing and signing time is included.

What did not work

Automated coding suggestion alongside the draft was cut. It changed clinician behaviour in a way the coding team could not audit, and the quality bar could not be agreed between the two functions.

Systems involved