HLM: Wasn't the whole idea of EHR to make care more efficient?
Sinsky: That was the hope, but it's a hope that has not been realized across all the tasks of care. There are some tasks that probably are more efficient with EHR but there are many tasks that take longer.
In my own practice some tasks, such as indicating the next test or treatments for patients, might take three-to-five seconds to orchestrate with a paper check list. Now that takes two to three minutes through the EHR. If you multiply that difference by the number of tasks that physicians and clinical staff do every day, it adds up to a large portion of the day.
HLM: How did it come to this?
Sinsky: Any individual initiative sounds like it only takes a minute or two to record this element or create this discreet data point, but then it adds up to what we've found in our study, which was that physicians were spending a large portion of their day not providing direct care to the patient but rather doing EHR and desk work.
HLM: Is this a learning curve issue that might improve as physicians get more comfortable with EHR?
Sinsky: That is a myth. This is a technology and regulation and implementation issue. These are not findings that are limited to a small segment of the physician population but are across the board.
HLM: Is it possible that this is time consuming on the front end, but that it leads to other efficiencies later in the care continuum?
Sinsky: I don't think that any of our practices in the study were new to an EHR. They were in a steady state. It wasn't about the first six months of getting all the patients demographic data into the record that was causing the problem.
HLM: How is this affecting the physician-patient relationship?
Sinsky: Most patients who have visited a physician in the past several years are aware that they are not getting the direct undivided attention from their physician that they've had in the past that they know is important to their care.
They know that physician has to divide their attention between them and the electronic health record. One common complaint is that their doctor isn't giving them eye contact or listening intently. Physicians hear that sense of dismay that the relationship has been altered by EHR.
HLM: Can someone else do that data entry?
John Commins is a senior editor at HealthLeaders.