Hours spent record-keeping may fuel
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[September 08, 2016]
By Lisa Rapaport
(Reuters Health) - For every hour doctors
spend treating patients during a typical workday, they devote nearly two
more hours to maintaining electronic health records (EHR) and clerical
work, a small U.S. study suggests.
Time spent in meaningful interactions with patients is a powerful driver
of physician career satisfaction, but increased paperwork and time on
the computer means less time for direct patient care, the authors argue.
“When you take people who were trained to be caregivers and put them in
the role of being a technician documenting their work, there is bound to
be a loss of joy and work satisfaction,” Dr. Susan Hingle of the SIU
School of Medicine in Springfield, Illinois, told Reuters Health by
While the goal of electronic health records is to improve the quality
and efficiency of patient care, the findings suggest that in reality,
EHRs are taking time away from physicians' interactions with patients
and families, said study leader Dr. Christine Sinsky, vice president of
professional satisfaction at the American Medical Association.
“Many physicians have voiced concerns that the cumulative effect of the
many well-intended efforts has been, paradoxically, to make it harder
for them to deliver quality of care,” Sinsky said by email.
To get a snapshot of how electronic record keeping impacts the way
doctors spend their time, Sinsky and colleagues analyzed data collected
on 57 physicians in four U.S. states.
The physicians worked in family medicine, internal medicine, cardiology
and orthopedics in Illinois, New Hampshire, Virginia and Washington.
Researchers looked at work activities two ways: medical students
directly observed the tasks physicians completed, and a subset of
doctors also filled out work flow diaries.
At least half of the doctors in the study were observed for at least
Roughly half of the participants had tools such as dictation support
services or documentation-assistant services to help with EHRs.
Overall, the physicians spent 27 percent of their time interacting
directly with patients and 49 percent of their time on EHRs and desk
work, the study found.
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The time spent on electronic paperwork was divided between
documentation and review tasks, and ordering drugs or other things
needed for patient care.
Doctors did spend about 48 percent of their time in exam rooms,
though only a little more than half of this time involved direct
face time with patients. Roughly 37 percent was devoted to EHRs and
Outside office hours, physicians spent another one to two hours of
personal time each night doing additional clerical work.
One limitation of the study is that patients could opt out of
observation, making the snapshots of workflow incomplete, the
authors note in the Annals of Internal Medicine. Researchers also
didn’t track the number of patients seen per hour, the complexity of
patients treated or the work activities of support staff.
Even so, the authors conclude that physician burnout may become more
likely when doctors get less time to spend treating patients.
Efforts to reduce administrative burdens and give doctors more time
to spend with patients may make it easier for physicians to focus
directly on providing care and help reduce the potential for
burnout, Hingle wrote in an editorial published with the study.
“I think that technology needs to be changed so that it is more user
friendly, less burdensome, and returns the focus to the patient's
story, rather than minute details that don't really impact patient
satisfaction or outcomes,” Hingle told Reuters Health.
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