Residents Spend 5 Hours on Electronic Charts per Day

Laird Harrison

February 24, 2016

Internal medicine residents spend at least 5 hours per day entering patients' data into electronic health records (EHRs), researchers say.

The finding adds to a growing body of evidence that computers gobble a huge proportion of healthcare providers' time.

"[T]o address resident satisfaction and thus improve motivation to provide patient-centered quality care, reducing the time residents spend on clinical documentation should be a priority," write Lu Chen, a medical student at the Department of Medicine, New York Methodist Hospital, Brooklyn, and colleagues.

Their study appeared in an article published in the February issue of the Journal of Graduate Medical Education.

Whereas some evidence suggests EHRs can improve the quality of care, the amount of time physicians spend on the records is emerging as an important issue. For example, switching from paper charts to electronic ones reduced productivity among residents by 30% at a hospital in Moreno Valley, California, researchers reported previously.

With that in mind, Chen and colleagues set out to document the time first-year residents spent on EHRs at a 691-bed university-affiliated community teaching hospital.

They tracked the amount of time each of the 41 residents were logged into the EHR system. A tracking system tallied the residents' active use, defined as more than three mouse clicks, 1700 "mouse miles," or 15 keystrokes per minute.

The residents took part in ambulatory, emergency, and inpatient care, including general medical floors, intensive care units, and step-down units. The researchers recorded their EHR usage for May, July, and October 2014 and January 2015.

Over the course of 4 months, the residents spent 18,322 hours to review 33,733 electronic patient record encounters (EPREs), defined as an active EHR usage for one patient's chart each day.

This worked out to 40 (±11) minutes per EPRE for July and 30 (±5) minutes in January.

In other words, in January, after becoming familiar with the system, the residents spent 5 hours charting for a maximum of 10 patients per day.

The decrease of 18% spent on EHRs from July to January was statistically significant (P < .001).The researchers noted a reduction in time in all four categories of EHR activity: 2 minutes for chart review, 2 minutes for orders, 3 minutes for documentation, and 2 minutes for all other activities.

Some residents picked up the technique faster than others. The researchers divided the subjects into a group of 20 "faster providers" who spent 33 (±5) minutes per EPRE on EHR activity and 21 "average providers" who spent 47 (±9) per EPRE in July.

But the gap had narrowed by January, when the faster providers spent 28 (±4) minutes, and the average providers spent 32 (±5) minutes.

The researchers acknowledged limitations of the study: It was conducted retrospectively at a single center, and the researchers were not able to tell anything about the quality of care or patients' satisfaction or the quality of the electronic documentation.

"Although increased familiarity reduced time spent on clinical documentation, a significant portion of an intern’s day is still consumed by clinical computer work," the authors write. "Our data correlate well with national survey data, showing that [internal medicine] residents spent more than 4 hours per day on clinical documentation. Furthermore, a nationwide survey revealed that residents’ perceptions of the time devoted to documentation were generally negative; residents felt that clinical documentation took time away from education, patient care, and more importantly, motivation to provide high-quality care."

The authors have disclosed no relevant financial relationships.

J Grad Med Ed. 2016;8:39-44. Abstract

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