Physicians Spend More Time on EMRs Than With Patients in ED

Susan London

September 27, 2013

Emergency medicine physicians spend nearly half their time entering data into electronic medical records (EMRs), according to a study conducted in a community hospital in Pennsylvania.

Robert G. Hill Jr, MD, from St. Luke's University Health Network, Allentown, Pennsylvania and colleagues analyzed time use in their emergency department and found that physicians spent 43% of their time, on average, performing data entry, or roughly twice as much as that spent on direct patient care. Their study was published online September 23 in the American Journal of Emergency Medicine.

During a busy 10-hour shift, their calculations suggested that a physician might perform a finger-numbing 4000 mouse clicks entering data.

"Emergency department physicians spend significantly more time entering data into electronic medical records than on any other activity, including direct patient care," the investigators note. "Factors such as operating system speed, server/mainframe responsiveness, typing skills, user-friendliness of system, interruptions, extent of training, opportunity to delegate tasks, and various environmental attributes can influence data entry time. Efficient use of the EMR system will increase physician productivity and hospital revenue," they maintain.

Although EMRs are now the federally mandated standard for medical records, they are still controversial, with hefty up-front costs and uncertain benefits, according to the investigators.

To assess productivity in using EMRs, the researchers studied 16 attending physicians, emergency medicine residents or interns, and physician assistants and nurse practitioners.

Each participant tracked 30 hours of his/her time, recording minutes per hour spent in 4 categories: direct patient contact, data and order entry, discussion with colleagues, and review of test results and prior records.

Results showed that the physicians spent a mean of 43% of their time on data entry (range, 18% - 68%) and just 28% in direct patient care. These findings were not affected by the use of speech-recognition software.

In a pooled, weighted analysis, physicians spent an average of 44% of their time on data entry. This compared with 28% in direct patient care, 12% reviewing test results and records, 13% in discussion with colleagues, and 3% on other activities.

The tabulated number of mouse clicks required for common charting functions and selected patient encounters ranged from a low of 6 for ordering an aspirin to a high of 227 for completing an EMR for a patient with right-upper quadrant abdominal pain through the point of discharge.

In total, during a 10-hour shift, a practitioner could perform between 3200 (assuming 2 patients were seen per hour) and 4000 (assuming 2.5 patients were seen per hour) mouse clicks.

Sensitivity analyses suggested that even a modest 10% increase in throughput (patients seen per physician-hour) in the emergency department would lead to a $1.77 million increase in annual gross revenue and a $212,826 increase in net revenue.

"In light of the financial benefits arising from even this modest increase in throughput, efforts to improve physician productivity are well advised," the investigators write.

"Electronic medical records provide numerous benefits under the right conditions," the authors conclude. "Functionality is expected to improve as this technology evolves to reach its full potential. Efficient integration of EMR systems into work routines will optimize physician time and improve data quality while increasing patient satisfaction and, ultimately, the bottom line."

The authors have disclosed no relevant financial relationships.

Am J Emerg Med. Published online September 23, 2013. Abstract


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