Physicians spend 16 minutes using EHR for each patient encounter

Physicians spend, on average, 16 minutes and 14 seconds using an EHR for each patient encounter, with 11% of that time occurring after hours, according to a study published in the Annals of Internal Medicine.

“The time physicians have to spend on indirect patient care tasks creates time pressure on direct patient care — interview, physical exam, discussion — adds to the physician's cognitive load and can be difficult to integrate into the time we have face to face with the patient,” J. Marc Overhage, MD, Ph.D., a health care information technology executive at Cerner Corporation, told Healio Primary Care.

Approximately 100 million patient encounters with 155,000 physicians were included in analyses.
 The average time spent actively using an EHR each month was 16 minutes and 14 seconds per encounter across all specialties, with 11% of that time accounting for work completed after hours.

Chart review consumed 33% of this time (5 minutes, 22 seconds), followed by documentation at 24% (3 minutes, 51 seconds) and ordering at 17% (2 minutes, 42 seconds).

Among primary care physicians, the mean active time using an EHR per encounter was 19 minutes and 48 seconds. Physicians in internal medicine spent an average of 18 minutes and 19 seconds using the EHR per encounter, and those in family medicine used it for an average of 15 minutes and 52 seconds per encounter.

Overhage said the findings provide important information on the amount of time that physicians invest using EHRs, which is often overlooked by patients and policymakers.

“It is, of course, important to maximize the efficiency with which physicians can care for patients,” he said. “The health care system also needs to be thoughtful about the tasks we ask physicians to do and which tasks other members of the care team, including the patient, can perform as well or better in order to free physicians to focus on their unique contributions.”

The situation is even worse for trainees

Residents Spend 5 Hours on Electronic Charts per Day

Trainees are hard-pressed to meet the demands of patients, attending physicians and study time. The facts in this story are disturbing because it takes away protected time for study, research, and collaboration.

To address resident satisfaction and thus improve motivation to provide patient-centered quality care, reducing the time residents spend on clinical documentation should be a priority," write Lu Chen, a medical student at the Department of Medicine, New York Methodist Hospital, Brooklyn, and colleagues.

Their study appeared in an article published in the February issue of the Journal of Graduate Medical Education.

Whereas some evidence suggests EHRs can improve the quality of care, the amount of time physicians spend on the records is emerging as an important issue. For example, switching from paper charts to electronic ones reduced productivity among residents by 30% at a hospital in Moreno Valley, California, researchers reported previously.

With that in mind, Chen and colleagues set out to document the time first-year residents spent on EHRs at a 691-bed university-affiliated community teaching hospital.

They tracked the amount of time each of the 41 residents was logged into the EHR system. A tracking system tallied the residents' active use, defined as more than three mouse clicks, 1700 "mouse miles," or 15 keystrokes per minute.

The residents took part in ambulatory, emergency, and inpatient care, including general medical floors, intensive care units, and step-down units. The researchers recorded their EHR usage for May, July, and October 2014 and January 2015.

Over the course of 4 months, the residents spent 18,322 hours to review 33,733 electronic patient record encounters (EPREs), defined as an active EHR usage for one patient's chart each day.

This worked out to 40 (±11) minutes per EPRE for July and 30 (±5) minutes in January.

In other words, in January, after becoming familiar with the system, the residents spent 5 hours charting for a maximum of 10 patients per day.

The decrease of 18% spent on EHRs from July to January was statistically significant (P < .001).The researchers noted a reduction in time in all four categories of EHR activity: 2 minutes for chart review, 2 minutes for orders, 3 minutes for documentation, and 2 minutes for all other activities

"Although increased familiarity reduced time spent on clinical documentation, a significant portion of an intern’s day is still consumed by clinical computer work," the authors write. "Our data correlate well with national survey data, showing that [internal medicine] residents spent more than 4 hours per day on clinical documentation. Furthermore, a nationwide survey revealed that residents’ perceptions of the time devoted to documentation were generally negative; residents felt that clinical documentation took time away from education, patient care, and more importantly, motivation to provide high-quality care."

Physicians spend 16 minutes using EHR for each patient encounter: