Primary care physicians spend more than half their day on EHRs, study says

Primary care physicians spend more than half of their total work day on electronic health records (EHR), according to a new study published in Annals of Family Medicine. That’s an average of 5.9 hours spent on EHRs out of an 11.4-hour work day (including clinic and after-clinic hours), researchers reported.

So many hours spent per day on EHRs contribute to work-life imbalance, dissatisfaction, high rates of attrition, and a burnout rate exceeding 50%, the researchers wrote.

“While physician burnout happens for a number of reasons, spending a good deal of the work day and beyond on electronic health records is one of the things that leads to burnout,” said the study’s lead author Brian G. Arndt, MD, Associate Professor of Family Medicine and Community Health at University of Wisconsin School of Medicine and Public Health, in Madison, WI. Researchers from the University of Wisconsin and the American Medical Association (AMA) conducted this retrospective cohort study.

The study included 142 family medicine physicians from a single health system administered by the University of Wisconsin. The researchers extracted from the EHR system the physicians’ event logs for both direct patient care and non-face-to-face activities during a 3-year period, which were validated by direct observation.

The results showed that the physicians spent an average 4.5 hours on their EHR during clinic each day, plus another 1.4 hours before or after clinic, for a total of 5.9 hours on the EHR per day. This backs up another recent study that found that for every one hour of direct patient care, physicians spent nearly two hours on EHR and other paper work. 

“When you factor in the non-electronic health records duties, it adds up to a work day of 11.4 hours, representing a significant intrusion on physicians’ personal and family lives,” Dr. Arndt said.

Almost half of the total time physicians spent on EHR is taken up by clerical and administrative tasks (44%, or 2.6 hours), including documentation, order entry, billing and coding, and system security. Other tasks, including medication refills, interpretation of lab and imaging results, letters to patients, responding by e-mail to questions about medications, and incoming and outgoing phone calls, accounted for another 1.4 hours (23.7%) of every work day.

“This study reveals what many primary care physicians already know—data entry tasks associated with EHR systems are significantly cutting into available time for physicians to engage with patients,” stated AMA President David O. Barbe, MD, MHA, a family physician from Mountain Grove, MO.

“Unfortunately,” he added, “clerical and administrative demands are not being reconciled with patient priorities and clinical workflow. Poorly-designed and implemented EHRs have physicians suffering from a growing sense that they are neglecting their patients and working more outside of clinic hours as they try to keep up with an overload of type-and-click tasks.”

“It is imperative to find ways to reduce documentation burden on physicians,” Dr. Arndt said, and offered at least a couple ways to do so. “Having clinical staff enter verbal or handwritten notes (based on a standardized checklist) could save time and allow physicians to focus more on the patient. In addition, documentation support by staff and additional training in documentation optimization should be available for interested physicians.”

Interestingly, the EHR event logs used in this study to tally computer time could also be used to identify areas of EHR-related work that could be delegated, Dr. Arndt suggested. This could reduce workload, improve professional satisfaction, and reduce burnout, he predicted.