Significant portion of ambulatory care time is spent on electronic health records

1. For every one hour that is spent on direct face time with patients, two hours are spent on electronic health records.

2. Physicians continue to spend significant time on electronic health records after office hours.

Evidence Rating Level: 4 (Below Average)

Study Rundown: Electronic health records (EHR) are an integral part of medical care provided in the United States. These store vast amounts of patient information, and provide important details that allow for sound medical management. In recent years, new evidence in the medical literature has emerged discussing the effects of EHR on physician satisfaction and patient outcomes. The present study is a direct observational study that quantifies the amount of time physicians from four different medical specialties spend their time in ambulatory care. These disciplines included family medicine, internal medicine, cardiology, and orthopedics. 57 US physicians participated in the study who were directly observed in clinic or provided self-reported diaries. The study found that physicians spent close to half of their time during an office day on EHR and desk work, and more than a third of their time in the examination room on EHR. Physicians that completed self-reported diaries also spent 1-2 hours each day after-hours on EHR tasks.

Overall, the study suggests that use of electronic health records comes at the significant cost of reduced clinical face time with patients. While the study is primarily observational in nature, and the sample size too small to demonstrate comparisons between specialties, it provides a useful trend that corroborates similar evidence in the literature. Future studies may consider identifying the effect of documentation support on clinical face time, or evaluating any relationship between physician use of resources and clinical, financial, and professional outcomes.

Click to read the study in the Annals of Internal Medicine

Relevant Reading: The Impact of Electronic Health Records on Time Efficiency of Physicians and Nurses: A Systematic Review

In-Depth [observational study]: Four disciplines in the medical field were chosen as a representative sample of physicians in the United States. These include family medicine, internal medicine, cardiology, and orthopedics. Sixteen practices from four states (Illinois, New Hampshire, Virginia, and Washington) were recruited. Both direct observation data of the physicians, and self-reported diaries were utilized for data source and measurement. Direct observations were limited to clinical office days and were completed by medical students who trained to use The Work Observation Method by Activity Timing (WOMBAT) software to record information. Physician work activity was described across four categories: direct clinical face time, EHR and desk work, administrative tasks, and other tasks. Self-reported diary of work was utilized to obtain information on after-hours work activity.

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