High EHR Burden for Some GI Providers

Megan Brooks

March 29, 2023

Among those who provide gastrointestinal (GI) care, electronic health records (EHRs) may be particularly burdensome for physicians who specialize in inflammatory bowel disease (IBD) or hepatology, as well as for nonphysician providers (NPPs), according to a new study.

IBD and hepatology specialists spend more time per appointment using the EHR, including for clinical review and outside of regular hours, compared to other subspecialists, the study finds. Additionally, NPPs spend more time in EHRs than physicians.

"Given the often-complicated medical histories of patients with IBD as well as the role of IBD specialists as de-facto primary care providers for many patients, these findings are not surprising," say Aman Bali, MD, and colleagues with the Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, Florida.

The finding that hepatology specialists show similar overall EHR burden as IBD specialists suggests that management of chronic disease in these patient populations may be contributing to this increased workload, they add.

The study was published online March 20 in The American Journal of Gastroenterology.

EHR Burden Dissected

Widespread adoption of EHRs has been shown to have significant benefits, but it's also been identified as a "key driver" of physician burnout. However, the EHR burden specific to GI providers had not been well explored.

To investigate, Bali and colleagues analyzed data collected through an analytics tool in their EHR system for 41 outpatient GI providers. The data covered 2803 clinic days and 16,407 appointments over the 6-month period of January 2021 through June 2021.

They compared metrics across provider gender; the subspecialties of IBD, hepatology (HEP), esophagus (ESO), advanced endoscopy (AE), and motility/irritable bowel syndrome (IBS); and training (physicians vs NPPs).

Overall, 76% of providers were physicians, and 24% were NPPs; 44% were women, including all the NPPs.

Among the key findings:

  • Female and male GI providers spent a similar amount of time in the EHR per appointment (22.2 minutes and 19.4 minutes, respectively).

  • IBD and HEP specialists spent more time in the EHR per appointment than other subspecialists (38.3 minutes and 34.6 minutes for IBD and HEP, respectively, vs 10, 11.2, and 19, for ESO, AE, and motility/IBS, respectively), including more time in clinical review. They also spent more time using the EHR outside of regularly scheduled hours per appointment.

  • IBD specialists also received more messages requesting medical advice per appointment than other providers (2.4 per appointment for IBD vs fewer than 1 to 1.2 per appointment for the other specialties).

  • Junior faculty spent more time outside of scheduled hours, including "pajama time" (5:30 PM to 7:00 AM and weekends), than senior faculty (21.1 minutes vs 14.8 minutes per appointment) and had a lower percentage of visits closed the same day (20.3% vs 57.1%), though comparison was limited by small sample size.

  • NPPs spent more overall time in the EHR per appointment than physicians (36.2 minutes vs 20.1 minutes), owing in part to increased time in clinical review per appointment (10.2 minutes vs 6.6 minutes).

  • NPPs received a similar number of medical advice request messages per appointment as physicians (1.4 vs 1) but spent more time per completed message (70.9 seconds vs 43.3 seconds).

More Research Needed

The findings align with a recent study that found "similar evidence of high EHR burden" for GI providers, Bali and colleagues say. In that study, for each hour of scheduled time, GI providers spent an additional 45–50 minutes on EHR-related tasks, though no statistically significant differences were identified when comparing NPPs to physicians.

Bali and colleaguessay the increased EHR burden of NPPs in their study may be explained by their institution's practice model, in which NPPs spend a significant portion of time seeing patients for follow-up visits. This allows physicians time for other tasks, such as procedures and research.

The study did not assess provider burnout and was limited to the metrics provided by their EHR system, the researchers note. Their findings are from a single tertiary care center that was using one EHR system; the findings may not be valid in different practice settings that use different EHRs, they add.

More data across various practice settings encompassing more providers are needed to understand the true landscape of EHR burden in GI. That knowledge will be essential to create strategies to address the problem, the researchers write.

The study had no external funding. The authors have disclosed no relevant financial relationships.

Am J Gastroenterol. Published online March 20, 2023. Abstract

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