Now EHR data entry 50% of primary care doctors’ workday: AMA, University of WI report

click to enlargeWhere’s the doctor? Typing away! A fact of life doctors have agonized on over the past ten years–even great advocates like Robert Wachter, MD above at NYeC last year–is the clerical burden of EHRs and patient data entry. A late 2016 time and motion study in the ACP Annals of Internal Medicine (AMA, Dartmouth-Hitchcock, Australian Institute of Health Innovation) noted a mere 49.2 percent of ambulatory physicians’ time spent on EHR and desk work. Mayo Clinic (above) has been tracking both the burnout and the burden as 50 percent (above).

Now we have a new three-year study published in the Annals of Family Medicine led by the University of Wisconsin Medical School tracking EHR data entry as 52 percent: 5.9 hours of an 11.4 hour workday. This includes allied clerical and administrative tasks including documentation, order entry, billing and coding, and system security accounting for 2.6 hours, close to 50 percent of the 5.9 hours daily.

Is there a way out? The study’s recommendations were:

  • Proactive planned care
  • Team-based care that includes expanded rooming protocols, standing orders and panel management
  • Sharing of clerical tasks including documentation, order entry and prescription management
  • Verbal communication and shared inbox work
  • Improved team function.

Much of this sounds like burden shifting to deal with the EHR, not a redesign of the EHR itself, but the commentary in AMA Wire makes it clear that it was shifted in the first place by the EHR designers from other staff to the doctor for direct entry. Other time savings could be realized through moving to single sign-on (versus dual entry passwords) to advanced voice-recognition software. (UW release)

The earlier ACP study excerpt in NJEM Journal Watch has physician comments below the article and they blast away:

  • an emergency physician now practicing outside the US who spends 1/3 of the time in documentation than he did in a US ED
  • a lot of the administration tasks in EHRs are around either paying the highest possible billing levels for service or have been dictated by Medicare to prevent fraud
  • a psychiatrist who can type at 80 wpm yet who is blocked by “a maze of dropdown menus and radio buttons to click, that are poorly placed and poorly organized by computer geeks who know little to nothing about the day to day business of doing medical office visits”–far worse than typing progress notes into a simple Word document. Psychiatry was also hit with a triple whammy: EHRs plus the changes to both ICD-10 and DSM-5 which resulted in complicated coding changes for psychiatric office visits. (This Editor can confirm all this personally as a factor driving many psychiatrists into retirement–over 59 percent are over 55 and they are not being replaced.) The result: rare eye contact with patients.

Something must be done to redesign EHRs and streamline the billing system, as not only MD burnout but also the intrusion on patient care is out of hand. The patient may want to see you now, to quote Dr. Eric Topol, but there may be no doctor to see you.

Also Healthcare IT News 

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Comments

  1. The current state of medical records keeping (EHR) is completely ridiculous. The EHR was designed by IT people for the billing office.

    What is needed is a redesign BY PHYSICIANS!. Let others (clerks) address the issues of billing “compliance” and meaningless use. This would go a long way to addressing the current and looming “doctor shortage”, by freeing up physicians’ time to treat patients instead of paper.

    We have done this at First Stop Health (www.fshealth.com). The record can be typed, voice dictated, dictated and transcribed, cut and pasted from a series of (individualized) macros, or combinations of the above at the choice of each physician. Our doctors love it and it minimizes the amount of time they need to spend on record keeping.

    • Donna Cusano

      Think of EHRs like a Christmas tree. Its once pristine branches are now overburdened with ornaments, tinsel, lights, and cotton snow. Once designed to automate workflow and preserve/share recordkeeping and imaging, ‘meaningless use’ and ACO quality measures (I recall 50 or more) have added more and more to what was pretty simple recordkeeping and patient notes. Add to this the tendency for IT people to overcomplicate because their brains work that way, and they are not end-user designers…

      A lot of simplification is required, including on the regulatory/HHS side.

  2. Doctors in the Hospital are ambulatory. If some further analysis is done, then another 10-15 % of time is spent moving around. If a mobile based workflow (for standard processes) is triggered then then the time spent on data entry shall reduce.

    • Donna Cusano

      @Mangesh, I don’t understand your logic. The measurement tracked any type of use. What you are talking about is displacement–using the EHR on mobile while walking around versus using it at the desk. And given the way EHRs are designed, that is a tall order!

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