A study of 42 family medicine physicians in one southern Wisconsin health system found that in a given 11 hour workday, nearly 6 of those hours are being spent in the electronic health record (EHR).
The research, published recently in the Annals of Family Medicine, included all Epic Systems EHR interactions that were captured from “event logging” records over a three-year period for both direct patient care and non–face-to-face activities, and were validated by direct observation. EHR events were assigned to one of 15 EHR task categories and allocated to either during or after clinic hours, according to the study’s authors.
The authors of the study, MDs who are affiliated with the University of Wisconsin in Madison, and with the American Medical Association (AMA), came to the conclusion that primary care physicians spend more than one-half of their workday, nearly six hours, interacting with the EHR during and after clinic hours. “EHR event logs can identify areas of EHR-related work that could be delegated, thus reducing workload, improving professional satisfaction, and decreasing burnout,” they stated.
Drilling down into the research, clinicians spent 355 minutes (5.9 hours) of an 11.4-hour workday in the EHR per weekday per 1.0 clinical full-time equivalent: 269 minutes (4.5 hours) during clinic hours and 86 minutes (1.4 hours) after clinic hours. Clerical and administrative tasks including documentation, order entry, billing and coding, and system security accounted for nearly one-half of the total EHR time (157 minutes, 44.2 percent). Inbox management accounted for another 85 minutes (23.7 percent).
What’s more, in the authors’ own primary care system, the University of Wisconsin-Madison health system, during 2013 to 2016, despite a stable 2.2 average office visits per panel member per year, telephone calls increased by 3 percent and MyChart portal encounters increased by 62 percent to an average of 0.66 per panel member per year. Most primary care physicians have not allocated time for this additional work, and much of the non–face-to-face work occurs on top of already full patient care sessions, the authors said.
The researchers noted how much of a family medicine physician’s workday (84 minutes) is spent on documentation, “so it is imperative to find ways to reduce documentation burden. Although EHR templates have improved documentation efficiency for some, the quality of the clinical note is often lower when compared with that obtained with dictation to transcription,” they said.
Indeed, burnout and the increased workload clinicians have experienced from time spent working in the EHR are due to multiple factors, they said—only one of which is the software itself. Other factors include inappropriate allocation of EHR tasks to clinicians (e.g., submitting a radiograph order that was given verbally in the past); technology-supported guidelines that have placed hard stops in clinical workflows (e.g., a clinician cannot proceed until acknowledging a post–hospital discharge medication reconciliation); the problem-focused care paradigm; healthcare workforce issues; more scrutiny on cost, quality, and patient satisfaction; and rapidly changing regulatory requirements, they opined.
This study’s results reflect on similar research published last year in the Annals of Internal Medicine, which found that during office hours physicians spent nearly 50 percent of their time on EHR tasks and desk work. Christine Sinsky, M.D., and her colleagues from the American Medical Association led that study; Sinsky was also involved in this new one.