PCPs Spend Half Their Workday Using EHR, Study Finds

Troy Brown, RN

September 12, 2017

Primary care physicians spend almost 6 hours of their workday, both during and after clinic hours, using electronic health records (EHRs), a new study finds. Moreover, two thirds of that time is spent on clerical and inbox work.

The researchers write, "[1.4 hours] per day of EHR time was spent outside of clinic hours (before 8:00 am or after 6:00 pm), including 51 minutes per weekend. This extra time equates to an average workday (excluding time providing care to patients in the hospital) of 11.4 hours, representing a considerable encroachment on physicians' personal and family lives."

Brian G. Arndt, MD, from the School of Medicine and Public Health, Department of Family Medicine and Community Health, University of Wisconsin–Madison, and colleagues report their findings in an article published in the September/October issue of the Annals of Family Medicine.

They extracted EHR system event logs for 142 family medicine physicians over the course of 3 years, totaling more than 118 million individual log record events, and used three broad categories to characterize the EHR-related work: clerical, medical care, and inbox.

Physicians spent just 32.1% of their EHR time on tasks in the medical care category (chart review–notes, 16.9%; chart review–medications, 7.3%; problem list, 3.4%; chart review–laboratories, 2.5%; evidence-based medicine and point-of-care, 1.1%; and chart review–imaging, 0.8%).

In contrast, almost half (44.2%) of physician's EHR time was spent on clerical tasks (documentation, 23.7%; order entry, 12.1%; billing and coding, 3.9%; system security, 2.8%; and administrative, 1.7%).

For example, on average, they spent 43 minutes of each workday on order entry. "The burden related to order entry has been associated with clinician burnout, dissatisfaction, and intent to leave practice," the authors write. One solution might be to have clinical staff enter physicians' verbal or handwritten orders into the EHR, they add.

Dr Arndt and colleagues say it is "imperative" to identify ways to reduce physicians' documentation burden. EHR templates have improved documentation efficiency in some cases; however, the quality of clinical notes is often inferior to dictated and transcribed notes. Interested clinicians should have access to documentation support staff and "additional training in documentation optimization."

Physicians spent 23.7% of their time on tasks in the inbox category (refills and results management, 15.5%; MyChart portal, 5.6%; telephone calls, 2.0%; and letter generation, 0.6%).

"[B]urnout and the increased workload clinicians have experienced from time spent working in the EHR are due to multiple factors, only 1 of which is the EHR system itself," the authors explain. "Other factors include inappropriate allocation of EHR tasks to clinicians (eg, submitting a radiograph order that was given verbally in the past); technology-supported guidelines that have placed hard stops in clinical workflows (eg, a clinician cannot proceed until acknowledging a post–hospital discharge medication reconciliation); the problem-focused care paradigm; health care workforce issues; more scrutiny on cost, quality, and patient satisfaction; and rapidly changing regulatory requirements."

The researchers believe increased face-to-face communication between clinical team members can improve efficiency, increase staff satisfaction, and lead to better patient outcomes. "Routing all communication among team members through the EHR adds layers of inefficiency and distracts the team from higher-quality verbal communication," they write.

The authors hope users of other EHR systems will analyze their own event-log data, using the same EHR task categories, to compare results and "help to determine whether this approach is generalizable."

The authors have disclosed no relevant financial relationships.

Ann Fam Med. 2017;15:419-426. Full text

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