By Lisa Rapaport
(Reuters Health) – For each patient they see, doctors spend about 16 minutes using electronic health records, a U.S. study finds.
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).”
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.