Hybrid care ups EHR-based work by 6% for primary care physicians

New research reveals that days when primary care physicians (PCPs) only provided telehealth did not increase their EHR-based work; however, on days when they provided both telehealth and in-person care, their EHR-based work increased by around 6 percent.

Published in JAMA Network Open, the study assessed whether administrative and EHR burdens increase for clinicians using both telehealth and in-person care. Telehealth skyrocketed during the peak of the COVID-19 pandemic when in-person care services were restricted. However, as in-person care resumed, surveys revealed an enduring preference for in-person care.

One survey that polled 2,202 United States adults in July 2023, after the public health emergency (PHE) expired, showed that only 6 percent preferred virtual care versus 53 percent who preferred in-person care. The survey also revealed that hybrid care was relatively popular across age groups.  

Thus, researchers from MedStar Health Research Institute and Georgetown University School of Medicine set out to evaluate the effects of hybrid care on EHR-based work for clinicians. They conducted a cross-sectional study that combined visit modality data with EHR active use information for MedStar Health PCPs using the Cerner EHR system from December 2021 through June 2023.

The research team categorized the percentage of daily visits conducted via telehealth into five levels: zero telehealth use, less than or equal to 10 percent, 11 percent to 25 percent, 26 percent to 99 percent, and 100 percent of daily visits.

They also analyzed five measures of active EHR time for each day that PCPs worked: total EHR time, documentation time, medical record review time, order time, and next-day documentation time.

The study included 316 PCPs observed across 67,894 days. The mean documentation time for PCPs was 71.3 minutes on zero-telehealth days and 87.1 minutes on days with up to 10 percent of total visits conducted via telehealth.

Using regression analyses, researchers observed that days with both telehealth and in-person care were associated with significantly greater EHR, documentation, and medical record review time. Days where 26 percent to 99 percent of total visits were conducted via telehealth were linked to 14.8 more minutes of active EHR time, representing a 5.6 percent increase, 4.7 additional documentation minutes, representing a 6 percent increase, and 5.5 additional medical record review minutes, representing a 6.2 percent increase.

“Greater EHR time may be due to increased multitasking during telemedicine visits, as PCPs simultaneously engage with patients and the EHR during telemedicine visits in ways that are not possible in person,” researchers wrote. “This multitasking may feel more efficient and therefore may not register as ‘burdensome’; further research should explore whether added EHR time associated with mixed-modality days further burdens PCPs.”

Additionally, the study shows that hybrid care had no association with next-day documentation time, indicating that PCPs were able to “absorbed added time into their workload.”

The study contradicts previous findings. Research published last November found that telehealth use during the COVID-19 pandemic was associated with an increase in the time physicians spent working in the EHR.

For the study, researchers examined weekly EHR metadata of physicians at the University of California San Francisco (UCSF) Health. They compared data from before the COVID-19 pandemic (August 2018 to September 2019) with data from the same period after its onset (August 2020 to September 2021). Telehealth use increased significantly from 3.1 percent to 49.3 percent during this time.

The research team found that physician time spent working in the EHR during patient-scheduled hours increased from 4.53 to 5.46 hours per eight patient-scheduled hours between the pre-pandemic and pandemic periods. Similarly, physician time spent working in the EHR outside patient-scheduled hours increased from 4.29 to 5.34 hours. The study further showed that additional work was largely related to documenting visits rather than messaging patients.