Characterization of Electronic Health Record Documentation Shortcuts: Does the use of dotphrases increase efficiency in the Emergency Department?

The problem of clinical documentation burden is ever-growing. Electronic documentation tools such as "dotphrases" were invented to help with the documentation burden. Despite the ubiquity of these tools, they are understudied. We present work on the usage of dotphrases within the emergency department. We find that dotphrases are most often used by medical scribes, they significantly increase note length, and are completely unstandardized as to their naming conventions, content, and usage. We find that there is inconsistent usage across and within providers and that there is much duplication in the dotphrase content. We also show that dotphrases have no effect on the time to complete and cosign a note. Finally, we demonstrate that even when accounting for patient complexity upon presentation, note authorship, and note length - notes with higher dotphrase usage are billed at higher billing levels.