Within specialties, researchers found wide variation in the distribution of time spent by physicians using EHRs, indicating significant potential for improvement.
A new research article provides details about the time physicians spend working with electronic health records (EHRs) for outpatient encounters.
At most outpatient practices across the country, EHRs have replaced paper-based systems for documenting and retrieving patient data. Among physicians, primary complaints about EHRs include their impact on physician burnout and conversion of clinicians to data entry clerks. Earlier research has found that EHRs are strongly associated with physician job dissatisfaction.
The new research article, which was published today by Annals of Internal Medicine, is a large-scale study. The research features 2018 data collected from nearly 100 million patient encounters with 155,000 physicians.
The research includes several key data points:
- On average, physicians in outpatient settings spent 16 minutes 14 seconds per patient encounter using EHRs
- Three clinical functions dominated time spent on EHR use: chart review (33% of time using EHRs), documentation (24%), and order writing (17%)
- Physicians in the endocrinology, gerontology, internal medicine, and primary care specialties spent the highest mean times using EHRs per patient encounter—ranging from 18 to 22 minutes
- Sports medicine (8 minutes) and physical medicine and rehabilitation (10 minutes) spent the lowest mean times per patient encounter
- Within specialties, there was substantial variation in the distribution of time spent by physicians using EHRs
"The time spent using EHRs to support care delivery constitutes a large portion of the physicians' day, and wide variation suggests opportunities to optimize systems and processes," the co-authors of the research article wrote.
Interpreting the data
The top two clinical functions that physicians spend time using EHRs—chart review and documentation—have opposing impacts on clinicians, the article' co-authors wrote.
"Despite the effort sometimes required to ﬁnd the relevant data in the EHR (33% of active EHR time devoted to chart review), physicians generally appreciate the improved availability of data. Documentation, on the other hand, accounts for the second-highest proportion of EHR time (24%) and is often a target of physician concern. Documentation may be easier to delegate than some other tasks," they wrote.
The third highest clinical function that physicians spend time using EHRs—17% of EHR use time writing orders—is a high priority activity that requires clinician attention, the co-authors wrote. "Ordering, particularly medication ordering in the ambulatory setting, is an important provider task because it is a basic tool for recording the speciﬁcs of the physician's intent and communicating these speciﬁcs to other team members."
Having EHR use times by specialty provides a valuable benchmarking tool for physicians and health system leaders, the co-authors wrote.
"Physicians can compare their own EHR time with the reported times for their subspecialty to understand their performance in the context of other providers. Health system leadership can use the data to gain realistic insight into the effort required by physicians to complete their work, including EHR use, and justify investment in optimizing the physician workﬂow in the EHR."
The EHR use time by specialty is also valuable for payers and policy makers, they wrote. "Payers can use the data to understand the level of effort required to complete this important part of a physician's work when using an EHR and consider adjusting their expectations for data capture considering the direct costs. Finally, policymakers may incorporate these data into EHR certiﬁcation processes and data capture expectations."
An editorial accompanying the research article says the scale of the study is impressive. "Others have tackled this same research, but they have studied only a single or small number of sites or specialties. As a result, this study provides perhaps the ﬁnal word on the question, how much time do outpatient physicians spend using the EHR?"
Christopher Cheney is the senior clinical care editor at HealthLeaders.
Three clinical functions dominated time spent on EHR use in the outpatient setting: chart review (33% of time using EHRs), documentation (24%), and order writing (17%).
To reduce administration burden on physicians, documentation should be a prime target for EHR improvement.
The times of EHR use by specialty provide a valuable benchmarking tool for physicians, health system leaders, payers, and policy makers.