Doctors spend twice as much time with EHRs than with patients

For every 1 hour that ambulatory care physicians spend with patients, they spend nearly 2 hours on electronic health records (EHR) and desk work during a regular office day. They also spend additional 1 to 2 hours of personal time at home each night to “keep up,” according to a time-and-motion study published September 6, 2016 in Annals of Internal Medicine.

So much time spent on EHRs instead of on patient care could be contributing to physician burnout, according to the study which was led by researchers from the American Medical Association (AMA).

“Time spent in meaningful interactions with patients and the ability to provide high-quality care are powerful drivers of physician career satisfaction,” the authors noted. “Dissatisfaction among physicians with how their time and skills are used is widespread and growing. Fifty-four percent of U.S. physicians experience some sign of burnout, an increase from 46% in 3 years.”

Although career satisfaction and physician burnout have been widely reported recently, little is known about how physicians actually allocate their time. For this study, which was funded by AMA, researchers observed 57 U.S. physicians in 4 states to record how they spent their time in ambulatory practice. Physicians were in primary care practices (family medicine and internal medicine) or specialty practices (cardiology and orthopedics). Of the 57 physicians, 21 also completed diaries about their after-hours work.

The researchers found that physicians spent 27% of their total office day on direct clinical face time with patients and more than 49% of their time on EHRs and desk work. In the exam room, physicians spent about 53% of the time on direct clinical patient interaction and 37% on EHRs and desk work.

The physicians who completed after-hours diaries reported 1 to 2 hours of additional work each night, devoted mostly to EHRs.

“Our results suggest that documentation support with either dictation or documentation assistant services may increase direct clinical face time with patients,” the authors noted.

“Electronic health records were implemented to improve the efficiency and quality of patient care, but they have yet to achieve that promise,” wrote Susan Hingle, MD, of Southern Illinois University School of Medicine in Springfield, IL, in an accompanying editorial. “Now is the time to go beyond complaining about EHRs and other practice hassles and to make needed changes to the health care system that will redirect our focus from the computer screen to our patients and help us rediscover the joy of medicine.”

Additional research could examine the effect of such strategies as scribes or advanced care teams on practice efficiency, physician burnout, and patient satisfaction, Dr. Hingle suggested.

Because this study included self-selected participants in high-performing practices, the researchers acknowledged that the findings may not necessarily apply to other settings.