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Docs Spend Too Much Time Behind a Computer

Only forty-nine percent of a doctor’s time is in front of the patient (Volume 9, Issue 48)

For years, the US has worked toward fully integrating electronic health records (EHRs) into healthcare systems in order to improve outcomes, quality of care, and cost-effectiveness, otherwise known as the Triple Aim. However, from physicians’ anecdotal experiences with EHRs, they are a time-consuming nuisance that takes time away from patients yet ultimately are better than keeping track of cumbersome paper medical records. How much time are physicians really spending on EHRs? And what are they doing on them?

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This study looks at EHR time stamps to see how much time internists, pediatricians, and family physicians spend face-to-face versus doing “desktop medicine” – typing progress notes, telephone encounters, sending/receiving secure messages, and refilling prescriptions. On average, physicians spent 49% of their time face-to-face with patients and 51% of their time on desktop medicine activities, which mostly comprised of typing up progress notes. The fact that physicians are spending so much time typing progress notes shows that time is taken away from directly interacting with patients. This notion of having to record everything that is done during the clinical visit onto the EHR is a source of physician burnout. With that being said, some of the “desktop medicine” activities, such as writing prescription refills and sending messages to patients, allows for remote interaction with patients, which leads to increased efficiency by (1) letting physicians see more patients and (2) not having patients waste their time going into clinic for some simple follow-up appointments.

The results of this study have two main take-away points. One is a call for payment reform to further de-emphasize fee-for-service models of care. With physicians spending time remotely interacting with patients to perform time-saving tasks such as refilling prescriptions and doing quick consultations, compensation needs to reflect these valuable processes instead of only accounting for in-office visits. The other is a need to alleviate unnecessary EHR burdens, like typing out progress notes, put on physicians. Such tasks take away time from physicians to directly interact with patients. Ways to incorporate scribes, improve the user interface, or train physicians to optimize their savviness with the EHR should be considered in order to reduce wasted time.

This Policy Prescriptions® review is written by Ryan Jacobs. Mr. Jacobs is a first year medical student at Baylor College of Medicine.

Abstract

Time spent by physicians is a key resource in health care delivery. This study used data captured by the access time stamp functionality of an electronic health record (EHR) to examine physician work effort. This is a potentially powerful, yet unobtrusive, way to study physicians’ use of time. We used data on physicians’ time allocation patterns captured by over thirty-one million EHR transactions in the period 2011-14 recorded by 471 primary care physicians, who collectively worked on 765,129 patients’ EHRs. Our results suggest that the physicians logged an average of 3.08 hours on office visits and 3.17 hours on desktop medicine each day. Desktop medicine consists of activities such as communicating with patients through a secure patient portal, responding to patients’ online requests for prescription refills or medical advice, ordering tests, sending staff messages, and reviewing test results. Over time, log records from physicians showed a decline in the time allocated to face-to-face visits, accompanied by an increase in time allocated to desktop medicine. Staffing and scheduling in the physician’s office, as well as provider payment models for primary care practice, should account for these desktop medicine efforts.

PMID: 28373331 Tai-Seale, M, et al. Health Affairs. 2017; 36 (4): 655-662.