Half of Physician Time Spent on EHRs and Paperwork — Physician’s First Watch

Medical News |
September 6, 2016

Half of Physician Time Spent on EHRs and Paperwork

By Kelly Young

Edited by David G. Fairchild, MD, MPH

For every hour spent with patients, physicians spend 2 hours on electronic health records (EHR) and desk work, according to an Annals of Internal Medicine study.

Researchers observed nearly 60 physicians from 16 practices during office hours. Physicians completed diaries documenting after-hours work.

Based on 430 hours of observation, 49% of physicians' office hours were spent on EHR and desk work while 27% was spent directly with patients. When meeting with patients, physicians spent 37% of their time on EHR and desk work. After office hours, physicians worked a mean of 1.5 hours per day, with most of that time dedicated to EHR tasks.

Physicians who had documentation support, such as dictation or a documentation assistant, had more direct interaction time with patients than physicians without support. An editorialist writes: "Learning colleagues' strategies to alleviate some of the practice hassles related to EHRs is a great way to move forward and make improvements."

Reader Comments (21)

George Physician, Family Medicine/General Practice, private

It seems that the time has come for there to be an audio recording that is the ultimate medical record. The paper is a condensed version of it- but what is recorded would be the main piece.

If turned off - for delicate times-- more notes typed or written can be used then.

The time has come for this to be used!

ROGER FELIX Physician, Family Medicine/General Practice, NextCare Urgent Care, Albuquerque

I couldn't agree more. Everytime Medicare changes standards for what has to go into a medical record, everyone has to jump to conform, and ROS is one of the most time-consuming and mind-numbing parts of this. I can understand that they were trying to keep clinicians from committing fraud, but it's gone too far. However, with respect to how much time it takes to complete a record, I worked with a primary care system whose method of progress note documentation was a lined piece of paper. I stayed a lot longer after work documenting then than I do with EHRs now.

Mark Sagarin Physician, Emergency Medicine

The American requirements on what you need to document in order to get paid are idiotic. When working in the US I need to go through a certain number of organ systems on the PE and ROS for a certain level of ED visit. I now work overseas in a country where we document whatever is truly important for good medical care, and everything is paid for because we actually have a healthcare system. My documentation time is about 1/3 as much, and furthermore there is no need to hire costly scribes to document for the doctors, as is now the case in my US employer's ED. The presence of a scribe in the room takes away from the one on one patient doctor encounter. One of my key reasons I want to continue to live overseas is TO NEVER HAVE TO DO A ROS ! I am serious about this. Who is the genius who invented these documentation requirements in the US?

John O'Brien PA Nurse/NP/PA, Family Medicine/General Practice

How, doctor, would one design a "double-blind" study of paper charts vs EMR? To paraphrase Inigo Montoya in "The Princess Bride," You keep using that word. I do not think it means what you think it means

Mary P. Bennett, RN Nurse/NP/PA, Other, Home Health Care

Must be the "new" math! As a nurse, and as a patient, I think the quality of personal contact is infinitely more important than the proliferation of documentation.

Harvey Klein MD Physician, Internal Medicine

The EHR ,as it has evolved, is mostly a device to supply documentation for the highest possible billing levels for professional services.Medical groups insist on this to maximize income.Much of it is boiler plate to inflate the fees. As such it has many of the characteristics of a gigantic fraud.So sad that our great and noble profession has come to this!

Zaloga, D.O., C.P.A. Physician, Nephrology

Healthcare has been taken over by "The Suits". "Obama Cost" is imploding before our very eyes. Today it's all about "The Dough" (i.e.: $$$$$). Until we take it back, it will continue to get worse.

CHARLES HERRON Physician, Other, Retired

Two hours on paperwork/EMR and one on patient care equals three hours of work. But those first two only account for half of the total? Who's doing your calculations? Interesting comment on a statistical report.

Martha Shuping, MD, MA Physician, Psychiatry, private practice

I saw the recommendation that patients learn to touch type. I type 80 words per minute and worked as a typist during my pre-med years. I know how to type but since the implementation of the EHR, PLUS the coding changes implemented in the U.S. in 2013, it is no longer possible for me to make eye contact with my patients, or at best, only at rare moments. Another choice is for physicians to go off insurance entirely - many physicians are doing very well in this manner, and it is possible to lower costs substantially by eliminating the support staff responsible for insurance billing, insurance credentialing, etc. In the U.S., many insurances are requiring patients to pay $50 or even $80 as copayment, and without the burden of electronic systems and extensive support staff, rates for some services can be decreased below what patients are currently paying. In the U.S. Medicare is exceptionally burdensome and there is NO evidence whatsoever that a total takeover of health care by the U.S. government would provide better care or less burden to the physician - in my experience, it is the complete opposite and Medicare is worst of all. It was the Medicare administration that forced U.S. physicians into EHR's in many cases before the electronic systems were really ready to roll out. Most of the electronic systems are MORE time consuming that if one could just type into a Word document, and even a trained typist with an 80 wpm typing speed cannot work quickly in a maze of dropdown menus and radio buttons to click, that are poorly placed and poorly organized by computer geeks who know little to nothing about the day to day business of doing medical office visits. In addition, it was horrible timing to roll out the requirement for EHR's during the same general time period as changing to ICD-10 and DSM-5 while also herding psychiatrists into extremely complicated coding changes for psychiatric office visits. Numerous psychiatrists I know have retired earlier than originally intended because of all these changes which were anticipated to be "not worth it." The excessive documentation requirements plus the effect of having to do it by EHR, which is much slower than just typing or writing by hand, and related factors are causing me to consider dropping insurance entirely in 2017. Many physicians have already made this change.

A. Seiffertt, D.O. Internal Medicine, self

The heading could be changed to "2/3 of time spent on EHR/deskwork." Since it's 1:2 ratio, this would seem more accurate. Or, even more accurate, less than 1/3 time spent with patients, and more than 1/3 of that is documentation DURING the visits. Meaning doctors spend less than 20% of time fully present with patients. I don't think patients or administrators or government officials understand how completely insane this is and how badly care and time with patients has suffered and will continue to suffer because of this awful system.

Donald Perlo Physician, Internal Medicine, United States

The EHR tail is wagging the clinical dog. Perhaps physicians need to unionize to have the leverage to change this situation. Some thoughts: 1) all visits are audio recorded, to be transcribed by admin staff or voice recognition software, and the MD documents physical findings and assessment/plan; 2) if the EHR can't be so modified, then demand 20-40 minutes per visit depending on chief complaint or other factors, 60 min for comprehensive new patient visits, and 20 minutes of admin time for every 40 minutes of patient care for documentation/coordination of care).

Stephen Kemble

If the "solution" is more documentation support, then that adds to physician office staffing and overhead, with offsetting savings. Why isn't anyone looking to reduce the complexity of documentation requirements? This is not about improving quality and reducing cost; it is about paying more middle men to micromanage doctors and forcing doctors to pay more to cope with those middle men. Where is the supposed "value" in this?

Andrea Demeter, MD Physician

As Schmookler above pointed out, and the astute daughter of Dr John Cooper quipped, 2 hours EHR:1 hour "doctoring " means 2/3 ratio. The title is misleading and concealing the true burden of EHR. It should read "Two thirds of physician time spent on EHR and paperwork".

JOSE GROS-AYMERICH Physician, Family Medicine/General Practice, INSS -retired

Hi!: I'd say time spend entering patient information, as H&P, orders, in an EHR is actually time spend with the patient, as most data entered in an EHR are mandatory. The issue may be rather if entering data by hand on paper takes longer or shorter than having data in an EHR, EHR have features, as automated warnings of drug and other allergies that add safety to the medical practice. I started using an EHR around 2003, and it's true that entering data for those who have no special typewriting skills may be time consuming, and also that having to look at screens puts an added wall in patient-professional relationship, but for issues such as Quality Assurance and Safety, EHR look highly valuable. Thanks, regards, + Salut

John Cooper MD PhD Physician, Family Medicine/General Practice, Clinic

Has there ever been a randomized, double-blinded outcomes study comparing patient outcomes in practices using electronic health records versus practices using paper-based record systems?

DALE HAVRE Physician, Ophthalmology

It's hard for patients to get eye contact with physicians in the examination room these days, while the docs are engaged in their EHR duties. I hear this complaint frequently from patients, and I can agree with them as a result of personal experience. At times it can be a diversion that might not be healthy for either of the parties.

Hugh Nelson MBBS Physician, Family Medicine/General Practice, Australia

British and Australian GP's find that EHR allows them to give better quality and time to patients. 3 key requirements. Learn to TouchType. Have decent software designed by clinicians rather than administrators. Have one funding body rather than hundreds.

John Cooper MD Physician, Family Medicine/General Practice, Clinic

Showed this to my daughter who is in the top of her senior high school class and has been considering entering premed. She told me, "Dad, I've done the math. After two years at the JC I can have an associate's degree in secretarial science. That will make me into two thirds of a doctor."

David L Fairbrook M.D. Physician, Internal Medicine, retired

As developmental partner - Beta site for EHR in 2007 I have watched the evolution of EHR. Until Medicare sent out "advisory" that hx present illness MUST be by physician, I have watched the efficiency,effectiveness of the EHR go from physician as "data analysts" to "data entry clerk".
Originally the nurses /patients comments went directly into the note, the PMH, FH,SH, were extracted and reviewed from previous and the "yes/no" questions of the Chief complaint - were answered directly from the computer derived data base directly to the note. The doctor then asked the detailed questions made analysis of data, wrote a note evaluating the problem,impression and development of treatment plan.
By lunch time all morning pt. records were completed, signed,billed done. Later I worked with Epic- no coordination of nurse - doctor information into the note, multiple "clicks" to enter data, and little time to actually talk, as your article demonstrates.
Physicians did NOT take ownership of the EHR in the beginning,and have not stood up to administrators, computer programers , or designers, resulting in 200 plus EHR's all trying to get docs to buy their program. It was a great beneficial, effective efficient idea, gone bad from the start. Glad I retired.

Schmookler Other, Psychiatry, Private

The math here is weird. 2 hours to 1 hour is 2/3, not half

Silvia Rudoy Physician, Moron Buenos Aires

It is the same in Argentina

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