Electronic Health Record Logs Indicate That Physicians Split Time Evenly Between Seeing Patients And Desktop Medicine

Abstract

Time spent by physicians is a key resource in health care delivery. This study used data captured by the access time stamp functionality of an electronic health record (EHR) to examine physician work effort. This is a potentially powerful, yet unobtrusive, way to study physicians' use of time. We used data on physicians' time allocation patterns captured by over thirty-one million EHR transactions in the period 2011-14 recorded by 471 primary care physicians, who collectively worked on 765,129 patients' EHRs. Our results suggest that the physicians logged an average of 3.08 hours on office visits and 3.17 hours on desktop medicine each day. Desktop medicine consists of activities such as communicating with patients through a secure patient portal, responding to patients' online requests for prescription refills or medical advice, ordering tests, sending staff messages, and reviewing test results. Over time, log records from physicians showed a decline in the time allocated to face-to-face visits, accompanied by an increase in time allocated HHS Public AccessAuthor manuscript Health Aff (Millwood). Author manuscript; available in PMC 2017 August 07. Author Manuscript Author ManuscriptAuthor Manuscript Author Manuscript to desktop medicine. Staffing and scheduling in the physician's office, as well as provider payment models for primary care practice, should account for these desktop medicine efforts.Physician time is a key resource in health services delivery. Understanding how physicians spend their clinical time is essential, given the need to understand practical capacity; guide staffing, scheduling, and support models in the physician's office; and improve the accuracy of payment for physician services. Fee-for-service payments are intended to reflect resources (captured as relative value units, or RVUs) used before, during, and after clinical encounters associated with face-to-face ambulatory care visits. 1-3 Questions have been raised about whether the reports underlying the RVU estimates are accurate and representative of true physician effort in providing patient care services. In the age of electronic health records (EHRs) with patient portals, patients often request services (such as prescription refills and medical advice) online, without face-to-face visits. Physician effort in addressing these online requests was absent from the original RVU calculations. [1][2][3] In addition to physician reports of their own efforts, 2,4,5 researchers have used time-andmotion studies 6 and video 7 and audio recordings. 8 While these methods capture significant physician effort, 6,9-11 they are costly to use and often evaluate only a limited number of physicians. Even the resource-based relative values scale (RBRVS) was built, for some specialties, on survey responses to vignettes from about twenty physicians. 1 This scale is still the chief tool used to determine the periodic updates to the Medicare Fee Schedule. Furthermore, concerns about the Hawthorne effect preclude ongoing, broad-based direct observa...

A Time-Motion Study of Primary Care Physicians’ Work in the Electronic Health Record Era

“…Our results of the time spent by the physicians working in the EHR are similar to a recent study that used EHR time stamp data from 471 primary care physicians. 29 They found physicians logged an average of 3.08 hours on office visits and 3.17 hours on "desktop medicine" each day, which is similar to the ratio we measured. They also noted a trend from 2011 to 2014 of declining time allocated to face-to-face visits, accompanied by increasing time allocated to desktop medicine.…”

The Association Between Perceived Electronic Health Record Usability and Professional Burnout Among US Physicians

“…[4][5][6] Physicians now spend 1 to 2 hours on EHRs and deskwork for every hour spent in direct face-to-face contact with patients, as well as an additional 1 to 2 hours of personal time on EHR-related activities daily outside of office hours. [7][8][9] Although time spent with the EHR has been attributed to the clerical burden of current documentation requirements, [10][11][12] poor EHR usability has been found to be a contributor to physician dissatisfaction, and many have hypothesized a direct relationship between EHR usability and physician burnout. 5,10,[13][14][15][16] Usability is "the extent to which a product can be used by specified users to achieve specified goals with effectiveness, efficiency and satisfaction in a specified context of use."…”

Opportunities for improving use of evidence‐based therapy in patients with type 2 diabetes and cardiovascular disease

“…Patients with T2D and CVD often require comanagement of several providers, including a primary care provider (PCP), cardiologist, and sometimes an endocrinologist. Yet, care coordination between these specialists can be constrained due to documentation burden on the electronic health record (EHR) . One study using the EHR logs of 471 primary care physicians found that physicians on average spent 3.2 hours per day on EHR documentation, of which less than 6% was on care coordination or making referrals .…”

“…12,13 One study using the EHR logs of 471 primary care physicians found that physicians on average spent 3.2 hours per day on EHR documentation, of which less than 6% was on care coordination or making referrals. 12 Even when patient care was coordinated across providers, poor communication among physicians could impose barriers to medical care. A survey of PCPs and specialists found that close to 50% of respondents reported a problem with the timeliness of referral information and that 30% were not satisfied with the referral content they received.…”