Ambulatory Docs Spend 5-Plus Hours on EHR Use Per Day

Ambulatory physicians spend more than five hours on EHR use for every eight hours of scheduled patient time, according to a study published in the Journal of the American Medical Informatics Association (JAMIA).

Research also revealed female physicians spend more time on the EHR than their male counterparts. Medical specialty and the number of practicing clinical hours are also associated with EHR use time.

Extended EHR use, documentation, excessive EHR inbox messages and notifications, and other EHR usability issues can result in clinician burnout.

And according to an assessment of both Epic Systems and Cerner EHR users, that extended EHR use time is common.

The researchers dissected ambulatory physician EHR use over one month at the Epic-based Yale-New Haven Health System (290 EHR users) and the Cerner-based MedStar Health System (283 EHR users). The researchers leveraged EHR vendor-derived platforms to compile EHR audit log data showing how physicians utilize EHR time.

The researchers aimed to dissect seven core EHR metrics: total EHR use time, out-of-office EHR use, EHR documentation, prescribing medication, inbox message response, medical orders, and provider-to-patient time.

Five of the seven core metrics were deemed measurable by the research team. However, some of the quantifiable metrics were imperfect or differed between the two EHR vendors, the study authors noted, rendering them unmeasurable.

For every eight hours of scheduled clinical time, physicians at the two health systems averaged a little more than five hours on the EHR. Of those 5.23 hours, the average clinician spent 33 percent of the time on documentation, 13 percent on inbox activity, and 12 percent on orders.

The study also revealed female physicians spent 0.58 more hours on the EHR than their male colleagues, even after the research team controlled for age, health system, scheduled clinical hours, and medical specialty. These figures are consistent with past literature.

Certain medical specialties, additional clinical hours scheduled, and physician gender was associated with average EHR time. On the other hand, physician age and EHR vendor were not predictive. It didn’t matter how old the physician was or whether she was using an Epic Systems or Cerner EHR, EHR use times were still long.

Surgical specialties, sports and physical medicine and rehabilitation, neurology and psychiatry users logged the fewest EHR time of the medical specialties.

“The findings from this cross-sectional analysis of EHR use in 2 large healthcare systems using different EHR vendor products indicate that it is possible to normalize EHR use across vendor products,” wrote the study authors. “However, in their current form, EHR audit logs and vendor-derived EHR use platform data have multiple limitations to allow derivation of all proposed core EHR metrics and comparison of metrics across vendor products.”

The study authors said differences in male and female physician patient panels and time spent per patient were not included in the study. However, different practice characteristics could contribute to added EHR time.

“Although gender is not associated with physicians’ perception of their EHR’s usability, future work could explore if gender differences in EHR use contribute to gender differences in physician burnout,” the research team wrote.

Furthermore, EHR use time among certain medical specialties is also consistent with several studies. In particular, procedural specialties spend less time on the EHR than others.

“This finding, along with the negative correlation between TW and multiple metrics, suggests that a team-based approach to EHR activities decreases the physician EHR burden,” the study authors explained. “Such an interpretation is consistent with previous assertions that a team-based care model decreases clerical burden and enables increased engagement with patients.” 

Although the study revealed particular vendor-derived EHR use data platform challenges, further understanding EHR use is critical to mitigate clinician burnout and boost patient care.

“Further transparency, granularity, and standardization of metrics across vendors is crucial to enhance the capability of hospital administrators, departmental leaders, and researchers to more accurately assess and compare EHR use across vendors and health systems,” concluded the study authors.

“Given these limitations, findings across systems should be interpreted cautiously. However, persistent differences in EHR use by specialty and physician gender remain compelling with important implications for EHR design, implementation, and policy.”