EHR use consuming physicians’ time for patients

Detailed analysis of doctors’ workdays finds they are spending increasing amounts of office and personal time keeping up with documentation requirements.

Physicians are spending more of their time struggling with burdensome electronic health records than they are providing direct patient care. And, in the process, doctor job dissatisfaction and professional burnout is growing.

Those are among the finding of a new study funded by the American Medical Association in which researchers observed 57 U.S. physicians in four states to quantify how their time was spent in ambulatory practice.

The time and motion study in four specialties—family medicine, internal medicine, cardiology and orthopedics—also involved doctors completing diaries to self-report their after-hours work.

Results published in Annals of Internal Medicine show that for every hour physicians provided direct clinical face time to patients, nearly two additional hours were spent on EHRs and other clerical work. And, when it came to outside office hours, doctors spent another one to two hours of personal time each night doing additional clerical work, mostly related to EHRs.

During daytime office hours, physicians dedicated 27 percent of their total time on direct clinical face time with patients and more than 49 percent of their time on EHRs and desk work, while in the exam room doctors spent almost 53 percent of their time on direct clinical face time and 37 percent on EHRs and desk work.

“If we look at the total clinic day, less than a third of that time a physician is actually giving direct patient care,” says Christine Sinsky, MD, lead author and AMA’s vice president of professional satisfaction. “And despite spending half of the work day on EHR/clerical work, physicians are still taking home one to two hours of data entry work at night and taking time away from their families and friends to complete these clerical tasks. This is not sustainable.”

Sinsky, who is a primary care physician in a community practice in Dubuque, Iowa, adds that the rate of physician burnout is very high and rising at an alarming rate.

“In 2011, 46 percent of U.S. physicians experienced some type of burnout and by 2014 that had risen to 54 percent, which is nearly double the rate of burnout in the general population,” she says. “We know that physician and other health professional burnout is not good for patients.”

As the article points out, previous studies have suggested that decreased time with patients and increased workload from EHR tasks are major contributors to career dissatisfaction among physicians.

In June, the Mayo Clinic—in collaboration with the AMA—released the results of a study of 6,500 physicians based on a national survey. In the survey, conducted between August and October 2014, doctors indicated that the use of EHRs and computerized physician order entry resulted in lower satisfaction and higher rates of professional burnout.

Writing in an editorial in the same issue of Annals of Internal Medicine, Southern Illinois University School of Medicine faculty member Susan Hingle, MD, credits the AMA-funded study with confirming what many practicing physicians already knew: EHRs occupy a lot of doctors’ time, while drawing attention away from direct patient care.

“Effectively addressing the challenges of modern-day practice requires such data as Sinsky and colleagues' study provides,” asserts Hingle. “These data document what physicians have long believed: The work of physicians has changed dramatically in recent years, at least partially due to EHRs. Additional time and motion studies would enable examination of the effect of strategies, such as scribes or advanced care teams, on practice efficiency, physician burnout and patient satisfaction.

“Now is the time to go beyond complaining about EHRs and other practice hassles and to make needed changes to the healthcare system that will redirect our focus from the computer screen to our patients and help us rediscover the joy of medicine.”

At the clinic level, Sinsky believes the solution is to “be very strategic about task distribution and distributing the work according to ability.” She argues that doctors who have some sort of EHR documentation support are able to spend a greater portion of their work day providing direct clinical face time to their patients.

“Physicians in our sample with documentation support spent more time on direct clinical face time with patients (31.4 percent for those with dictation and 43.9 percent for those with a documentation assistant) than those without documentation support (23.1 percent),” concludes the study.

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