EHR – Excessive Heinous Record-keeping

January 30, 2017

EHR – Excessively Heinous Record-keeping
This is not an ED-based study, but it strikingly demonstrates the inordinate burden of time that electronic health records require.  In ambulatory settings, clinicians routinely spent 1-2 hours after clinic to complete the EHR.  For every hour spent seeing patients, they spent almost 2 hours on EHR and desk work.

Spoon Feed
If you feel like most of your shift is spent on documentation, that’s because it is.  Reducing the burden of documentation must become a priority.  With all the brilliant people who read this, what solutions would you suggest? Please comment!

I’ll start the conversation with a few ideas.

1. Only require documentation of relevant information.  Why do I need to check a box that says I gave multiple doses of narcotics when there is already an electronic record that I ordered multiple doses of narcotics?
2. Make an EHR that requires as few clicks as possible.  EHRs seem to be designed to increase the number of screens, pop-ups, warnings, and drop-downs.
3. Compensate clinicians for time spent doing documentation (within reason).

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Abstract

Ann Intern Med. 2016 Dec 6;165(11):753-760. doi: 10.7326/M16-0961. Epub 2016 Sep 6.

Allocation of Physician Time in Ambulatory Practice: A Time and Motion Study in 4 Specialties.

Sinsky C1, Colligan L1, Li L1, Prgomet M1, Reynolds S1, Goeders L1, Westbrook J1, Tutty M1, Blike G1.

Author information:

1From the American Medical Association, Chicago, Illinois; Sharp End Advisory, Hanover, New Hampshire; Australian Institute of Health Innovation, Macquarie University, Sydney, Australia; and Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire.

Abstract

Background:

Little is known about how physician time is allocated in ambulatory care.

Objective:

To describe how physician time is spent in ambulatory practice.

Design:

Quantitative direct observational time and motion study (during office hours) and self-reported diary (after hours).

Setting:

U.S. ambulatory care in 4 specialties in 4 states (Illinois, New Hampshire, Virginia, and Washington).

Participants:

57 U.S. physicians in family medicine, internal medicine, cardiology, and orthopedics who were observed for 430 hours, 21 of whom also completed after-hours diaries.

Measurements:

Proportions of time spent on 4 activities (direct clinical face time, electronic health record [EHR] and desk work, administrative tasks, and other tasks) and self-reported after-hours work.

Results:

During the office day, physicians spent 27.0% of their total time on direct clinical face time with patients and 49.2% of their time on EHR and desk work. While in the examination room with patients, physicians spent 52.9% of the time on direct clinical face time and 37.0% on EHR and desk work. The 21 physicians who completed after-hours diaries reported 1 to 2 hours of after-hours work each night, devoted mostly to EHR tasks.

Limitations:

Data were gathered in self-selected, high-performing practices and may not be generalizable to other settings. The descriptive study design did not support formal statistical comparisons by physician and practice characteristics.

Conclusion:

For every hour physicians provide direct clinical face time to patients, nearly 2 additional hours is spent on EHR and desk work within the clinic day. Outside office hours, physicians spend another 1 to 2 hours of personal time each night doing additional computer and other clerical work.

Primary Funding Source:

American Medical Association.

PMID: 27595430 [PubMed – in process]