EHR Burdens Leave Docs Burned Out, in Critical Condition

Physicians spend two-thirds of their day completing tasks on cumbersome electronic health records systems. It's a leading cause of physician burnout, research shows.

The electronic medical records that came with a promise of improving care efficiency are instead forcing physicians to spend more face time with a computer screen than with their patients.

An observational analysis and survey of 57 primary care and specialty physicians in four states that was detailed this week in Annals of Internal Medicine shows that for every hour a physician spends providing direct clinical face time with a patient, nearly two additional hours are spent on EHRs and administrative tasks.

The time it takes to record a wide array of EHR data points has become a leading factor in physician burnout, says study lead author Christine Sinsky, MD, a Dubuque, IA-based internist, and vice president of professional satisfaction for the American Medical Association.

Sinsky spoke with HealthLeaders Media about her study. The following is an edited transcript.

HLM: Are you surprised by these findings?

Sinsky: We expected there would be a large portion of the day directed toward EHR and administrative tasks, but the extent we found was more than we expected.

HLM: What's driving this?

Sinsky: It's a cumulative effect of many well-intentioned interventions in healthcare. More specifically, EHR simply takes longer than it does in the non-EHR world.

On top of that, the EHR has become the vehicle for implementing other ideas that may be helpful toward improving healthcare, performance measurements, and additional data collections. These may have some benefits, but they have also had this downside of consuming more and more physician time.

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?

Sinsky: Advanced team-based models of care, where a clerical or clinical assistant helps with record keeping, has been one of the solutions to allowing the physicians to maximize their skills for the benefit of the patients. But there is simply a lot more data entry work than in the past.

We need to reconsider the notion that physicians are the appropriate team member to do data entry. That is not giving society the best return on investment in training of physicians.

One doesn't need 11 years of training to do any of the data entry and retrieval tasks that are so time consuming with EHRs. Very few other industries take their most highly trained individuals and have them spend the majority of their day that another employee or team member could do. It's time for us to reconsider that role in medicine.

HLM: What other solutions do you recommend?

Sinsky: We need EHRs that are designed to delight the users and right now that is not one of the criteria. We need to count up the number of clicks to do the task and compare that across different products. For example, with my EHR it takes 32 clicks to document giving a flu shot. I would love to see vendors compete on the ability to reduce the number of clicks to do a task.

HLM: What are the physicians in your study saying in their diary entries?

Sinsky: The main takeaway, and this is a good thing, is that physicians are driven to deliver quality care for their patients and anything that gets in the way of that is a source of burnout.

The physicians feel responsible for absorbing those external threats to delivering quality care and protecting the patients. But it's come to the point where physicians can no longer keep absorbing more clerical tasks and still do the work for which we have been trained.

HLM: What should be done with your findings?

Sinsky: First of all, it is helpful to see what is going on, the anatomy of the physician's day, to understand the magnitude of the time that is spent on administrative and clerical tasks.

Then we need to have greater adoption of some of the innovations that have been initiated across the country to bring the physician back to full attention for the patient.

I would love it if organizations read this study and then began doing their own pilot innovations with advanced team-based models of care. Regulators can look at the study and start to reflect on the cumulative effects of the many well-intended regulations that are having the unintended opposite effect on the quality of care that patients receive.