Study: EHRs bloat clerical workload for docs

Telemedicine

For every hour physicians spend in exam room visits with patients, they spend nearly two hours on electronic health record and desk work during office hours, a new study funded by the American Medical Association finds. 

The study, published in the Annals of Internal Medicine, used trained observers to document how 57 U.S. physicians in family medicine, internal medicine, cardiology, and orthopedics spent their time. In addition, 21 of them completed after-hours diaries.

“This study reveals what many physicians are feeling--data entry and administrative tasks are cutting into the doctor-patient time that is central to medicine and a primary reason many of us became physicians,” AMA Immediate Past President Steven Stack said in a statement. “Unfortunately, these demands are not being reconciled with patient priorities and clinical workflow. Clerical tasks and poorly-designed EHRs have physicians suffering from a growing sense that they are neglecting their patients as they try to keep up with an overload of type-and-click tasks.”

The observations covered 430 hours of physician time in practices in Illinois, New Hampshire, Virginia and Washington. They found that the doctors spent 27 percent of their day in direct clinical face time with patients and 49.2 percent of their time on EHR and desk work. In the exam room, physicians spent 52.9 percent of the time interacting directly with patients and 37 percent on EHR and desk work. What's more, after-hours work was devoted primarily to EHR tasks.

The observers also found that doctors spent an additional one to two hours afterward “catching up.”

Desk work included reviewing test results, writing medication orders and other tasks. Doctors spent only about 1 percent of their time on administrative tasks such as insurance and scheduling.

The 26 physicians who used documentation support, such as dictation or a documentation assistant, engaged in more face time with patients than those who did not.

An accompanying editorial, written by Susan Hingle, a professor of internal medicine at Southern Illinois University School of Medicine, notes that previous research found decreased physician satisfaction and increased cases of burnout among physicians who use EHRs and computerized physician order entry systems.

She points to the AMA’s STEPS Forward program and the American College of Physicians’ “Patients Before Paperwork” initiative as important efforts to reduce administrative burdens.