Clinicians still face high demand for patient communication

EHR data shows increased burden of electronic messaging during the pandemic, raising concerns over heightened burnout risk.

Even though the COVID-19 pandemic resulted in disruption of face-to-face encounters between patients and clinicians, doctors didn’t see any reductions in time using electronic records systems.

That finding, from an analysis of data related to use of Epic health records systems by ambulatory physicians, demonstrated the shifting in caregivers’ workloads that occurred over the first year of the pandemic.

The study, published last week in the JAMIA Journal, was based on national data pulled from Epic users at 366 health systems across the U.S., tracking shifts in caregiving from December 2019 to December 2020.

The cross-provider study shows the capability of EHR data to not only provide grist for studying clinical treatment, but also to analyze workflow and other factors impacting clinician performance and workloads over time.

The study found an actual increase in clinicians’ use of electronic records systems, driven by higher demand to respond to patients’ medical advice messages and requests for clinical review of medical information sent to them.

The results of the research initiative were compiled by A. Jay Holmgren, of the Center for Clinical Informatics and Improvement Research, University of California San Francisco, as well as researchers from Stanford University and the Harvard Business School.

“Clinician time spent in the EHR per day dropped at the onset of the pandemic but had recovered to higher than pre-pandemic levels by July 2020,” the study found. “Time spent actively working in the EHR after-hours showed similar trends.”

The study found a 157 percent increase in messages from patients, compared with pre-pandemic levels. “Each additional patient message was associated with a 2.32-min increase in EHR time per day,” the researchers estimated.

The shift to using virtual care, such as telemedicine, was supported by information technology systems, which was a positive factor in enabling clinicians to provide care to patients during lockdowns and capacity restrictions at healthcare organizations. But that placed new burdens on clinicians to ensure that patients’ information was accessible through portals and that their questions were answered expeditiously.

“As telehealth and the pandemic incentivized patients to become familiar with the use of online portals to access their health information and connect with clinicians, the time required for those clinicians to manage the care of their patients through the EHR increased,” the researchers concluded. “The long-term shift to a mix of face-to-face and virtual care, as ambulatory patient volume returned in the second half of 2020, may have exacerbated these issues as clinicians delivered care across multiple modalities in a single day.”

As patients now expect electronic communication with clinicians and this trend “may persist beyond the COVID-19 pandemic, it is critical to evaluate how they have impacted clinician work,” the researchers say. The shift to greatly increased time responding to these communications because of the pandemic increases the likelihood that work will be shifted to times outside of regular work hours.

That becomes another factor that must be weighed as clinicians experience burnout, because of the stresses of the pandemic and longer hours associated with EHR usage. Previous studies and surveys of clinicians suggest that time spent on EHRs after hours and message volume are associated with exhaustion among care providers.

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