Reducing After-Hours Charting With Smarter Healthcare Technology

For many physicians, the workday does not end when the last patient leaves. Notes still need to be completed, orders reviewed, messages answered, and records updated. That extra EHR time often spills into evenings, creating what clinicians sometimes call “pajama time.”

The burden is not small. In 2024, 22.5% of physicians reported spending more than eight hours per week in the EHR outside normal working hours, according to the American Medical Association. The same AMA data found that physicians averaged 57.8 working hours per week.

After-hours charting is not just about gaining the speed of the clinicians’ typing hands. Healthcare companies have to look at the point at which documentation starts, why notes are never completed, and what kind of tools can take out repetitive tasks without losing accuracy.

How an AI Scribe Medical Tool Can Reduce Documentation Work

An AI scribe medical tool can capture information from a patient encounter and prepare a structured clinical note for the physician to review. Instead of building every note from an empty template, clinicians begin with a draft based on the conversation.

That difference can come into play during a hectic clinic day.

A physician can care for patients back to back, separated by just a few minutes. Otherwise, if the notes aren’t completed at each encounter, they start to pile up. At the end of the schedule, the clinician may find themselves with a list of charts that they need to complete.

Some of that backlog can be cleared up by using an automated draft to move documentation closer to the actual encounter.

Clinicians must still confirm the note. All diagnoses, medications, findings, assessments, and plans should be reviewed prior to signing the record. There should be no attempt to take the physician off the documentation. The purpose of this is to minimize repetitive labor around it.

Why Notes Keep Following Clinicians Home

The pressure that leads to after-hours charting typically is a build-up of many little issues, not one big one.

Appointments run long. There are further issues with patients. Visits are not the only time for messages. Laboratory results must be attended to. This case was a complex one and required a more in-depth approach than the time schedule permitted.

Documentation is delayed when there is more important work to be done with the patient.

After this occurs multiple times during the day, clinicians can end up with 5, 10, or more notes still open. Those charts are then used alongside personal time in the evening to complete.

The EHR itself can introduce friction. All of these take time – repetitive clicking, template searching, entering data that’s already been entered elsewhere, and switching screens.

Documentation could also involve physicians having to piece together a situation hours after it has occurred. It takes more mental energy to remember the exact order of symptoms, discussion points, and follow-up information when it’s late in the day.

Documentation should be improved to minimize the amount of clerical work and should eliminate retrospecting visits.

Capture Information While the Encounter Is Fresh

One of the advantages of the ambient documentation technology is that it is practical.

If a note draft is created during or just after the appointment, the clinician can review it during or soon after the appointment. This is much easier than going back a few hours later to the chart to be able to remember all the important points.

Typical clinical discussions don’t follow the structure of a clinical note.

A patient might start with a symptom, move on to a concern about the medication, possibly reference a previous diagnosis, return to the original problem, and then ask another question as they exit. The doctor decodes this conversation as it happens.

With the traditional documentation, this work of the organization is repeated later in the documentation.

Technology can reduce this repeated effort by identifying relevant parts of the conversation and moving them to sections like history, assessment, and plan.

It is not meant to be final, though, and should be considered a draft. The value is to provide a good starting point for the clinician.

Reduce Keyboard Time During Patient Visits

After-hours charting is tightly coupled with what happens during office hours.

When doctors cannot complete their documentation between visits, they face a dilemma: type as they speak to the patient or delay documentation.

Neither is ideal.

Peterson may not be able to give attention to the patient during the entire encounter if they are busy typing. Postponing leads to greater in-person interactions, but after the timeline is complete, there is more work to be done.

The other alternative is to capture some of the information from the encounter without having to enter it all manually, which is known as ambient clinical documentation.

Doctors will continue to use computers for their previous notes, to access test results, to write orders, and for other clinical work. The aim is not to make the examination space screen-free.

Rather, the technology can limit the amount of patient conversation that needs to be manually reconstructed by typing the conversation.

This could help more paperwork be completed before the physician leaves the clinic so it can go to a review-ready state.

Measure Whether After-Hours EHR Time Actually Falls

Assessing healthcare technology should be based on what changes following its implementation.

Polished and a reduction of workload are not synonymous.

If the physician saves 5 minutes in creating the document but takes 6 minutes of his time to correct information, it has not improved the process.

Organizations should compare workflow data before and after adoption. Useful measures include:

• Time spent documenting after scheduled clinic hours
• Average note completion time
• Percentage of notes closed on the same day
• Number of unsigned charts at the end of clinic
• Time required to edit generated drafts
• Frequency of factual corrections
• Clinician satisfaction with documentation
• Continued use after the initial trial period

Attention needs to be given to after-hours EHR time, as this is related to clinician well-being.

A study indexed by the National Library of Medicine found that physicians reporting five or fewer hours of after-hours charting per week were more than twice as likely to report lower burnout scores than physicians charting six or more hours.

This doesn’t mean that if you don’t cut charting time you won’t burn out. It does reveal why it is important to measure “work outside of work.”

Accuracy Cannot Become the Tradeoff.

Speed matters, but clinical accuracy matters more.

Healthcare conversations include information that automated systems can misinterpret. The names of the medication, dosage numbers, abbreviations, dates, accents, background noises, and specialty language can all be issues.

Context is another concern.

Now let’s pretend that a patient complained of shortness of breath 3 months ago, but it is no longer a problem. An AE that is present as a symptom in the automatic note makes the record misleading.

Clinicians therefore need a consistent review process.

Particular attention should be paid to:

• Medication names and doses
• Allergies
• Diagnoses
• Relevant positive and negative findings
• Test results
• Measurements
• Laterality
• Assessment language
• Treatment decisions
• Follow-up instructions

The finest documentation process minimizes low-value typing while maintaining the physician’s control and oversight of clinically relevant information.

Better Templates Can Prevent Editing From Becoming the New Burden

A note that is accurate, but not written in the same fashion as the physician’s note can become a work problem.

There are various needs for specialties.

It’s important for a primary care note, psychiatric evaluation, orthopedic follow-up, cardiology consultation, and emergency department encounter not all to be identical.

During implementation, therefore, the design of a template should be taken into account.

The clinician needs to be able to describe the preferred structure of the notes, typical sections, level of detail, and the language used within the note for a particular specialty.

Another desirable characteristic of the system should be to avoid producing excessively long notes.

When writing a chat conversation, it’s easy to include all parts of the conversation, especially if the text is generated automatically. However, an increase in text doesn’t necessarily increase the utility of the record.

A brief note that succinctly and comprehensively communicates the patient’s condition and medical plan may be easier for the next provider to understand than a few pages of redundant or insignificant detail.

EHR Workflow Matters as Much as Note Quality

Though note quality is crucial, EHR Workflow Matters.

You can produce a great document with a documentation tool but not end up with a great document in the medical record if you have to do a lot of extra steps to get the document there.

Doctors already use a number of EHR screens, inboxes, order menus, and patient communication apps. If you add another application that is not connected to the system, it could add to frustration.

The organization should test the entire process of talking with patients through to chart signature.

Examples of questions to ask are:

What happens to the draft when it is added to the EHR? Must the physician copy and paste sections by hand? Are there any system templates to match? What is the maximum number of changes that can be made? What do you do if the tool breaks when the encounter happens?

The little things that make a workflow happen can make or break whether or not physicians continue to use the technology after initial hype.

Give Clinicians Time Back Instead of Filling Every Minute

Another key organizational issue is what to do about the existing players?

So what does happen to the time that is saved by documentation technology?

If all the minutes recovered are used for another appointment, then doctors are unlikely to see much improvement in their workload.

The actual benefit of after-hours charting may lie in giving the clinician time to complete his chart closer to the end of the day he is scheduled.

This could be increased time to look over a complex case, to respond to a patient’s important inquiry, to talk with a colleague, or walk out of the clinic without an unfinished pile of notes.

Healthcare organizations shouldn’t see documentation technology as a way to drive patients in the door.

A more accurate assessment of success would be if clinicians are able to do the job they need to do within reasonable working hours.

Start With a Focused Pilot

Implementing new documentation technology can make an immediate impact by making it easier to identify problems.

Clinical teams are given a space to test the process through a focused pilot.

When possible, include physicians from various workflows and specialties. Make regular visits and also to challenging cases. Listen to patients who speak in different ways, have several people speaking, are on a phone call, use medical jargon, and have complex health experiences.

Next, elicit from the clinicians what changed.

Have notes been closed and opened earlier? Did fewer charts get done at home? Spend Less Time Typing With Visits? What kind of errors did you see more than once? Was there a time-saving benefit added with writing?

Those answers are more helpful than just measuring how fast the software can produce text.

Smarter Documentation Should Protect the End of the Workday

While after-hours charting is becoming the norm in many clinical environments, it shouldn’t be taken for granted or accepted as an inevitability for physicians.

Better documentation practices can help to minimize some of the evening work required to complete charts. Seeing what happens on the spot, creating drafts that are organized, and incorporating documentation in the workflow more naturally into the current EHR process can enable physicians to complete more work while still at work.

The best part of the technology is that it’s most beneficial when organizations hold themselves to strict standards of accuracy, workflow design, privacy, clinician review, and measurable outcomes.

It won’t solve all the physician workload issues. It can solve one problem; however, that’s the stack of unfinished notes that awaits you after the last appointment!

That’s a significant step up for doctors and the healthcare systems they serve if it lets clinicians close their medical records sooner and free up more time away from work.

Frequently Asked Questions

1. Can AI scribes reduce after-hours charting for physicians?

Yes. AI scribes can take notes and document information from patient visits in a structured format for the doctor to review. These tools could shorten the amount of repetitive documentation tasks for the clinician and may help them write notes closer to the time of the clinic visit, thus avoiding charts that are not completed after clinic hours.

2. How can healthcare organizations measure whether an AI documentation tool is working?

Organizations can take a look at their documentation workflows before and after. Measures that are useful include: Average time to complete an EHR note, same-day note closure rate, number of unsigned charts, number of notes edited after they have been created, factual errors in notes, and clinician satisfaction.

3. What should physicians check before signing an AI-generated clinical note?

Physicians should review important clinical information, including medication names and doses, allergies, diagnosis, test results, measurements, laterality, assessment language, treatment decisions, and follow-up instructions. Documentation that is created by AI should be considered a draft until it is checked for accuracy by the clinician.