EHRs and physician burnout: Advancing the story

Photo: rosefirerising via Flickr

Photo: rosefirerising via Flickr

For every hour that physicians spend with patients, they spend nearly an additional two hours on electronic health record (EHR) tasks and desk work each clinic day, according to a new study published, fittingly, on Labor Day.

The study is sure to add to the debate over how much EHR tasks are contributing to physician burnout.

Many reporters have tackled the subject of physician burnout in their own communities, and physician leaders have called for more clinician support in computer and administrative tasks.

This new study, published in the Annals of Internal Medicine, focused only on physicians working in ambulatory care practices.  The researchers spent 430 hours observing 57 physicians practicing in four states (Illinois, New Hampshire, Virginia and Washington state). The physician practices were in family medicine, internal medicine, cardiology and orthopedics.

While during the examination room, the physicians spent about half their time (52.9 percent) on direct patient face time, and 37 percent of time on EHR and desk work. In the overall office day, they spent about half their time doing EHR or desk work, and 27 percent of total time on direct clinical time with patients.

Additionally, 21 physicians completed after-hours diaries and reported another one to two hours of work each night, mostly doing EHR tasks. The study was funded by the American Medical Association.

So what EHR tasks were taking up so much physician time? Recording details about the patient encounter took up the most time (38.5 percent of total time). Other EHR-focused activities included accessing test results, ordering medications and vaccinations and providing referrals. Administrative tasks included health insurance and claims paperwork and scheduling patients.

The researchers noted that two physician practices agreed to participate in the study but then withdrew, saying they “couldn’t cope“ with anything extra.

In an accompanying editorial, Dr. Susan Hingle of the SIU School of Medicine in Springfield, Ill., wrote that study confirmed anecdotal reports that “EHRs, in their current state, occupy a lot of physicians’ time and draw attention away from their direct interactions with patients and from their personal lives.”

For reporters, how can we advance the story beyond physician burnout? The study and editorial offer some resources. Are physician practices in your area engaged in any of these attempts to improve the physician workday? What has been the response or success in reducing physician computer burdens?

  • Training strategies for time management: The AMA has a program called STEPS Forward that uses online modules and live events to teach strategies for time management and achieving better patient management.
  • Tips on reducing administrative work: The American College of Physicians has a “Patients Before Paperwork“ initiative to reduce administrative burdens.
  • EHR design changes to be more clinician-friendly: The ACP also has a position paper “Clinical Documentation in the 21st Century“ that offers recommendations on EHR design and clinical documentation.
  • Clerical support: Documentation support with either dictation or documentation assistance can increase clinician face time with patients, the authors of the study wrote.

As journalists, we can explore to what degree physicians are being overburdened by computer work and whether strategies to reduce those burdens are helping.

2 thoughts on “EHRs and physician burnout: Advancing the story

  1. Avatar photoEileen Beal

    It’s hardly surprising that physicians….with a whole new task (requiring different skills, additional time, etc.) added to their woooooooooooooooooooork day is leading/has lead to burn out.

    Every time I hear the phrase “work to the top of their licensure” I wonder who in the world invented that phrase/idea/concept…and, more to the point, I pity the person who is expected to be fully engaged — and be so every minute of every working day — in a profession that (for the majority of those in it) is fraught with all forms (physical, emotional, mental) stress.

    Don’t believe me….then think about this: The very idea of expecting someone — especially someone who is good at what they do — to work at the top of their licensures (which, when you actually step back and think about it, means working on the toughest, most emotionally and mentally exhausting cases) ALL THE TIME….is crazy.

    Working on only the toughest cases means there aren’t all that many successes…and those are limited in scope and duration. It means there are few professional (and, sigh, personal) rewards (the very thing that holds people in a demanding profession). It means that there’s a lot of exhaustion and NOT a lot of “me/mine” time (necessary for recharging the well and sustaining important relationships). It means a lot of depression (and substance abuse to mask it).

    And…duh…it means burnout…waaaaaaaaaaaay quicker than it used to come on.

    At the conf this year, I spoke — outlining my above concerns — with one of the panelists, a new doc (maybe 25 or so) on one of the panels.

    His response, when I’d finished my “expecting-you-to-be-‘on’-all-the-time” is THE recipe for burn-out reality check was: “Gosh, I’d never thought of it that way.”

    Nor, I’m betting (and I’m not a betting woman), did those in health care policy making who thought up and are now championing the “practice to the top of your licensure” idea.

    E. Beal, Cle, OH

    Not surprisingly, the burn-out we are going to be seeing in health care will come at year 3-4-5, not a year 13-14-15, as it is ).for family, for decrompressing, for that holds people in , rewards (the very glue that holds us ALL in a demanding profession). It means that (i.e. at the top of their licensure)

    s” (aka “working

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