Medical interns spent as much as seven hours a day on electronic health records and clocked an additional five hours a day on them even after they got used to the systems, according to a small study published in the Journal of Graduate Medical Education.
The researchers, from New York Methodist Hospital and St. Georges University School of Medicine in Granada, used a built-in tracking program to objectively quantify the EHR usage data of all 41 first-year internal medicine residents in a single program, using audit logs for May, July and October 2014, as well as January 2015. They tracked only active EHR use, defined as an electronic patient record encounter, which included chart review, orders, chart documentation and other activities, such as communicating with other providers via the EHR.
The researchers found that the interns spent an average of seven hours a day in active EHR use in July, when first starting to use the system. By January, the time had dropped, but still amounted to roughly five hours a day. The average number of minutes per electronic patient record encounter dropped from 41 minutes in July to 30 minutes in January. The researchers surmised that the numbers decreased as the interns became more familiar with the systems, improved efficiencies, and other factors.
However, five hours a day on the EHR is still longer than time spent with paper records, the researchers noted.
"Although increased familiarity reduced time spent on clinical documentation, a significant portion of an intern's day is still consumed by clinical computer work," the researchers said. "[F]urthermore, a nationwide survey revealed that residents' perceptions of the time devoted to documentation were generally negative; residents felt that clinical documentation took time away from education, patient care and more importantly, motivation to provide high-quality care. This has been linked to reduced resident satisfaction and increased burnout."
To that end, the researchers said that reducing the time residents spend on clinical documentation must be a priority.
Other studies have shown that medical students, residents and physicians spend less time directly with patients when they use EHRs and have been struggling to incorporate EHRs into their patient care activities. The American Medical Association has recommended that medical students be provided with more EHR access and education; tools are also being developed to teach medical students how to use the systems better.
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