What is the ED provider note and why is it important?
The Emergency Department (ED) Provider Note is a critical document summarizing a patient's Emergency Department visit, including medical history, course of treatment, and follow-up plans. Historically, U.S. notes were overly long due to billing incentives, but recent billing changes focus on medical decision-making (MDM) and patient risk, eliminating the incentive for lengthy notes. To streamline note-writing, generative AI technology, like Abstractive Health, condenses medical records into concise summaries aligned with MDM and patient risk.
When you end up in the ED, your treatment is summarized into one important document called the ED Provider Note. This note details your ED stay with the following information:
- Medical History: Who are you and what is your previous medical and surgical history. This section can also include allergies, social history, and the list of medications you are currently taking.
- Arrival Info: Why did you end up needing Emergency treatment and how were you assessed before arrival.
- Arrival Chief Complaint and HPI: What was your initial presenting medical concern along with the story documented in the ED regarding your chief complaint.
- Review of Systems: What are the signs or symptoms that you may be experiencing, organized by body system.
- Physical Exam: A systematic evaluation of your body, including vital signs, general appearance, and specific findings for each relevant organ system.
- Clinical Impression/Assessment Plan: What the attending physician thinks is your medical condition in the ED and the initial workup including labs, imaging, and treatments.
- ED Course: What were the important lab results, pertinent imaging findings (e.g. x-ray or CT), consultation decisions, reassessment of vitals and physical exam findings for you throughout your time at the ED.
- Disposition / Follow-ups: Based on the physician determining what’s been happening to you, what are the next steps in your care plan:
○ Should you be discharged home, sent to ED observation units, urgently taken to the operating room (OR), or admitted for further treatment?
○ Should you be given further medications or procedures?
○ Who should look further into your treatment after you leave the ED such as referral to specialists or scheduling outpatient treatment/imaging?
The ED Provider Note has traditionally been long in the United States--too long. Downstream physicians, such as inpatient physicians or family medicine physicians, would prefer a succinct note that summarizes your visit. Unfortunately, it’s historically been long winded because our billing system rewarded it as such. A study found that US clinical notes in the US are 4x longer than the rest of the world for this reason.
Historically, ED attending physicians were compensated based on the number of body systems they reviewed in their notes. However, in 2023, the Centers for Medicare and Medicaid Services (CMS) replaced this billing system. The change was prompted by the growing length of notes, which contributed to physician burnout and offered limited benefits to the healthcare system. Consequently, ED Provider Notes often included exhaustive lists of lab reports, imaging results, and bedside procedures, obscuring the critical information amid the excessive data.
Given the volume of patients that are seen in our Emergency Departments in the US, physicians have little time to write an adequate ED Provider Note. So Electronic Health Record (EHR) systems like Epic and Cerner created note templates that extract all the previous patient content and automatically input it into the note. These note templates were not built with any AI and are not designed to synthesize the patient chart with any rhyme or reason. All they have generally done is a data dump and little thought is given to keep the notes succinct. The reasoning is that ED attending physicians could potentially make more money with longer notes if they just documented every little detail. Extensive research has indeed demonstrated that shorter notes would benefit downstream physicians. However, the US billing system inadvertently created a counterproductive incentive. Moreover, the practice of physicians excessively documenting information, such as employing templated 10-point review systems for procedures they didn't perform, not only introduces inaccuracies but also exposes physicians to potential malpractice liabilities. Thus, the quality of documentation within the ED Provider Note in the US healthcare system has suffered.
With the new billing changes taking effect in 2023, the incentive for writing longer notes no longer exists. Now, ED physicians will be reimbursed based on their medical decision making (MDM), aka skill-level, for each patient. MDM is not based on how many body systems the physician reviewed, but instead on how risky the patient is and how challenging the course of treatment is for the physician. Physicians should author ED Provider Notes with the intention of succinctly summarizing with respect to MDM. EHR templates that haphazardly extract data no longer have any benefit.
One of the best ways for doctors to speed up their note writing with the new billing changes is to use generative AI that automatically abstracts and summarizes the most salient data; EHR note templates are not designed for this level of sophistication. The generative AI system would condense the entire patient’s medical record into a few key sentences in seconds and create an ED Provider Note that properly considers the physician’s MDM and the risk-level of the patient. The physician would then just briefly review and sign-off on the note. With Abstractive Health, this is what we are doing for the ED Provider Note. We are currently piloting our technology at a few medical centers in the United States and globally.
If you are interested in automating your ED Provider Notes, contact us at Abstractive Health and we’d love to give you a demo and explain more of how it all works.