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 Researchers examined approximately 100 million patient encounters
with about 155,000 physicians from 417 health systems. They
collected data on every keystroke, mouse click and second of time
spent on various tasks in electronic health records (EHR) throughout
2018.
Across all specialties, physicians spent the most time in EHR doing
chart review, which accounted for about 33% of total time using the
records and an average of about 5 minutes and 22 seconds per
patient. They spent about 24% of EHR time on documentation,
averaging 3 minutes and 51 seconds per patient, and 17% of EHR time
ordering things like lab tests, for an average of 2 minutes and 42
seconds.
"Chart review, documentation, ordering, etc. are all tasks that
physicians have done for a very long time," said study co-author Dr.
J. Marc Overhage, who did the work for Cerner Corporation, developer
of the EHR used in the study. Overhage is also a Cerner shareholder.
"EHRs have made some of that work much easier," Overhage said by
email.
Chart review is probably faster and more complete using computers
than it was under older paper-based systems, Overhage said.
Improving chart review was one goal of widespread EHR
implementation, because more compete charts and more thorough chart
review by physicians has been associated with better outcomes.
Documentation and ordering is a somewhat different story, Overhage
said.
These tasks were faster before the advent of EHR, but speed may have
sometimes come at a cost, Overhage said. Computers, he noted, have
removed handwriting errors and helped to document and enforce
quality standards.
"Hand-written prescription (one kind of order) legibility is a
well-documented patient safety issue - one which EHRs have largely
eliminated," Overhage said. "Physicians may not have been doing a
good job of creating usable documentation and orders (even though
they might have been able to do so faster)."
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While the distribution of time spent using EHRs varied greatly
within a specialty, the proportion of time spent on various
clinically focused functions was similar across specialties.
The study wasn't designed to prove whether EHR use improves patient
care or whether physicians spend more or less time on computerized
tasks than they did under older paper-based systems.
Still, the amount of time providers spend using EHRs to support the
care delivery process is a concern for the U.S. healthcare system,
not only for cost related to patient care but also because of
physician burnout and job dissatisfaction, researchers note in the
Annals of Internal Medicine.
"We don't know how much of the time is spent in valuable ways -
doing more comprehensive documentation to create a more complete
patient record, responding to alerts that reminded the physician to
do something they might have otherwise forgotten, etc.," said Julia
Adler-Milstein of the University of California San Francisco School
of Medicine.
While it's not clear whether EHRs are a waste of time, it is clear
that computers are transforming how doctors work in ways that could
impact patient interactions, Adler-Milstein, author of an editorial
accompanying the study, said by email.
"Whether it's EHRs or anything else that is taking a doctor's
attention away from the patient, patients should feel empowered to
speak up if they feel that they have not been given the opportunity
to share all pertinent information with their doctor or feel that
their doctor might have missed something because their attention was
directed elsewhere," Adler-Milstein advised.
SOURCE: https://bit.ly/3a4PtNe and https://bit.ly/3a87iLx Annals of
Internal Medicine, online January 13, 2020.
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