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Study: Ambulatory Physicians Spend Half Their Time on EHRs, Desk Work

September 6, 2016
by Heather Landi
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Confirming what may practicing physicians have claimed, a recent study published in the Annals of Internal Medicine found that during office hours physicians spent nearly 50 percent of their time on electronic health record (EHR) tasks and desk work.

Researchers concluded that for every hour physicians provide direct clinical face time to patients, nearly two additional hours is spent on EHR and desk work within the clinic day, And, outside office hours, physicians spend another one to two hours of personal time each night doing additional computer and other clerical work.

The time and motion study, led Christine Sinsky, M.D. and her colleagues from the American Medical Association, was funded by the AMA.

The study was based on observations of 57 physicians who work in ambulatory care in four specialties—family medicine, internal medicine, cardiology and orthopedics, in four states, Illinois, New Hampshire, Virginia and Washington. Researchers observed how much time physicians spent on four specific tasks, direct clinical face time, EHR and desk work, administrative tasks and other tasks and self-reported after-hours work.

Researchers observed that during the office day, physicians spent 27 percent of their total time on direct clinical face time with patients and 49.2 percent of their time on EHR and desk work. While in the examination room with patients, physicians spent 52.9 percent of the time on direct clinical face time and 37 percent on EHR and desk work. In addition, about one-third of the physicians also completed after-hours diaries and they reported one to two hours of after-hours work each night, devoted mostly to EHR tasks.

In an accompanying editorial published in the Annals of Internal Medicine, Susan Hingle, M.D., from SIU School of Medicine, wrote, “Sinsky and colleagues confirm what many practicing physicians have claimed: Electronic health records, in their current state, occupy a lot of physicians' time and draw attention away from their direct interactions with patients and from their personal lives.”

As reported by Healthcare Informatics, a recent study published in Mayo Clinic Proceedings concluded that health IT plays a role in physician burnout. According to a national study of physicians led by Mayo Clinic, the use of EHRs and computerized physician order entry (CPOE) leads to lower physician satisfaction and higher rates of professional burnout.

Regarding the allocation of physician time in ambulatory settings study, Hingle wrote that the study findings have important implications for patient care and outcomes. “Many studies have documented lower patient satisfaction when physicians spend more time looking at the computer and performing clerical tasks. Patient satisfaction can affect health outcomes via adherence to the care plan and can also affect physician and hospital reimbursement, so the stakes are high.”

Hingle also noted that half of the study practices had documentation support services (dictation or a documentation assistant) available to physicians. Physicians in practices with these supports spent more time on face-to-face interaction with patients. Learning colleagues’ strategies to alleviate some of the practice hassles related to EHRs is a great way to move forward and make improvements, and professional organizations have begun to facilitate such learning.”

And Hingle concluded that 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.”

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