Charting. I have yet to meet someone who enjoys it. Charting is the one thing that unites every member of the health care team; everyone charts, everyone needs the chart to be up to date, all roads lead to the chart. If I told you that you never had to chart on another patient again, how happy would you be?
For such a crucial part of the health care landscape, it is shockingly not something that we are not routinely taught how to do, much less how to do efficiently or effectively. We get a brief orientation to the software and we are turned loose to sink or swim. Many of us tend to learn what not to do when we are scolded — having too many charts open, not coding something for maximum reimbursement, not responding to portal messages quickly enough … the list goes on. We learn the hard way, generally through trial and error. What a frustrating, slow, backward way to learn such a vital part of our job.
I jokingly call myself a charting fanatic. Not because I love charting, but because I am highly motivated to get my charting done as efficiently as possible so that I can move on to literally any other task. I've learned a few things along the way that have helped me to keep my charting and time management game on track — including closing 97% of my charts the same day four quarters in a row.
A clarification: "Charting" is more than writing notes to summarize your patient visit. Visit notes are an important element of charting, but charting as a concept is much more broad. Charting includes everything that happens in the EHR or that relies on the EHR: patient messages, refill requests, prior authorizations and peer-to-peer reviews, referrals, new patient record review, resulting labs, and so much more.
1) Keep the Note Brief
Just as you do not need to know that the patient with the broken ankle also has an allergy to dust mites, your visit notes do not need to cover everything about the patient every time. Keep it focused on the matter at hand (What was the injury that caused the broken ankle? What did the patient do on their own about the broken ankle? Are there any other relevant factors worth mentioning?), and leave the other stuff for another visit. Problem lists, surgical histories, med lists — those will get automatically imported to give context to your note. Write about what you saw and what you did.
2) Keep the Visit Brief
Visit notes are meant to reflect what was evaluated during the visit and your plan to address it. If you evaluated 10 different things in a single visit, you are going to have a lengthy visit and a lengthy note. If you keep the visit reasonably focused, it will make your charting burden less significant.
My rule of thumb is 10 minutes per concern. In an appointment-based ambulatory setting, that usually means two or three concerns per 20–30 minute visit. If your visits are shorter, there is less that you are going to be able to safely evaluate without running over. (Emergencies are always an exception, but true emergencies should be handled by the ED.)
3) Look at What You're Actually Doing
When I took a position in a subacute setting after working in an appointment-based ambulatory setting for years, my time management game felt very off. After having been so consistent with closing my notes and keeping my charting on track regularly, I found myself wondering why I was spending so much time dictating, typing, clicking. I decided to get some objective information to go along with my subjective information; I grabbed my notebook and started tracking my time for a few work days. How much time was I spending on seeing patients? Dictating? Entering orders and clicking everywhere?
Once I tracked this information for a few days, it became clear that I was actually getting done with everything sooner than I thought. It felt like it was taking longer because I was used to the structure of an appointment-based clinical setting; rounding on patients often meant visit lengths were much more variable, which presented a curve to feeling like I was in control of my time. Tracking and reviewing how I was actually using my time made a huge difference and allowed me to relax about how I was carving up my time each day. If I was done by 4 p.m., I was on track.
4) Set Some Boundaries
Leave me alone when I am charting. I am easily distracted by conversations that are not even meant for me, and if I am interrupted, it takes me time to get back into the groove of what I was doing. Task switching is a drain on all of us. It's a major drag on my productivity. But when I am in the zone, I can crank things out very efficiently and get a lot done.
I have decided to do everything that I possibly can to protect myself when I am charting so that I stay on track and cross that finish line. I close the door, I hang a sign requesting that I not be disturbed (with exception of emergencies, of course), sometimes I even put in foam earplugs. And I never take charting home, ever.
5) Learn to Delegate
You may have received the implicit message that you have to do everything: the buck stops with you. You may have internalized that and it may be showing up as a lack of delegation. Unless you work completely alone, which is rare, you have some colleagues around who are able to help with some of what you need to get done.
Even if it is as simple as not interrupting you when you are charting, there are things that others can do in service of the need to keep up with charting. Normal lab result? Add a note to the lab result in the patient portal or send a form letter. Patient portal message? If it's going to take more than a couple of minutes to respond or require discussion with the patient, that should be a visit, not a series of messages; have the person who schedules your appointments give them a call. Patient coming in with burning and frequency of urination? Empower your staff to know that they can collect a urine sample and dip it before you even see the patient, and tee up orders for routine urine analysis that you can simply review and sign.
When my charting is done more effectively and efficiently, it benefits everyone. When my colleagues are seeing my patient, they have my assessment and plan available for review. My employer gets to bill for that visit as soon as possible (and since it can take months to receive payments, the sooner that bill goes out, the better). The staff that I work with can access the information that they need in order to do their jobs more easily and efficiently. My patients get to benefit from having access to their information as soon as is reasonably possible.
Most importantly, it benefits me. I get to leave work at work, without a host of open notes hanging over my head or waiting for me when I return. I get to wipe the slate clean at the end of each day and start as fresh as possible on the next day. I get to live my life outside of work and maintain appropriate boundaries between work and home life. And everyone gets to benefit from the fact that keeping my charting in its proper place addresses burnout before it becomes a problem.
If you are struggling with everything that goes into charting, please know that this does not represent a personal flaw. It represents a flaw in our system, wherein we are presented with a large and challenging facet of our jobs with little to no preparation for how to do it. Who wouldn't at least stumble with something like that?
What are your charting tips and tricks? Share in the comments.
Jessica Reeves is a nurse practitioner as interested in the well-being of her fellow clinicians as that of her patients — and she's on a mission to make the work world a better place to live. She writes, works, and lives in the town that holds the world record for most lit jack-o-lanterns (really). Follow her at jessicareeves.net. Jessica was a 2023–2024 Doximity Op-Med Fellow and continues as a 2024–2025 Doximity Op-Med Fellow.
Illustration by Diana Connolly
