We’ve adopted electronic medical records (EMR) over 10 years ago when the upfront costs were high and the training curve was steep. One of the reasons for our early adoption was that we were running out of space for paper charts in our small Manhattan office. We also knew that EMR would improve the quality of care and safety – it allows us to see the lists of problems, allergies, medications, and other information at a glance on one screen. Sending prescriptions electronically dramatically reduces errors and saves time. Being able to log onto our system from home improved the after-hours care of our patients. We’ve never regretted implementing EMR years before EMR was mandated by the government.
Now for the negatives. A recent study by Dr. Christine Sinsky and colleagues published in the Annals of Internal Medicine is entitled, Allocation of physician time in ambulatory practice: A time and motion study in 4 specialties.
For this study, fifty-seven ambulatory care physicians in four specialties (family medicine, internal medicine, cardiology, orthopedics) in four states were directly observed for 430 hours. Twenty of these physicians also completed after-hours diaries. The results were striking: physicians spent 27% of their time on direct clinical face time and 49% on electronic health records and deskwork, while the rest was spent on administrative and other tasks. Even in the exam room, physicians spent 53% of the time on direct clinical face time and 37% on electronic health records and deskwork. They also spent 1-2 hours each night after office hours devoted primarily to electronic health records completion. The authors determined that for every hour physicians spent in direct clinical face time with patients, they spent additional 2 hours on electronic health records and deskwork during the clinic day and 1-2 hours of personal time finishing up electronic health records and deskwork at night.
So, when you see a doctor or a nurse practitioner, keep in mind that in addition to the time he or she spends with you, they have to spend twice as much time typing information into the computer, completing disability, insurance, and other forms, speaking to doctors and pharmacists, answering emails, staying up-to-date with latest medical discoveries, and doing other work. Dr. Neil Busis, writing in Neurology Today comments that the study confirms what we already know, that EHR use adds considerable clerical burden to practice. The study authors found that the use of EMR have decreased satisfaction and increased the risk for professional burnout. Physicians who burn out are at a significantly greater risk for depression and are more likely than satisfied colleagues to provide lower-quality patient care and to leave clinical practice early. Dr. Busis also notes that for many years the Centers for Medicare and Medicaid Services were telling doctors that they are not interested in listening to complaints until doctors can demonstrate that their policies will adversely affect their beneficiaries by decreasing access to care. This study provides such information. The idea is not to stop using EMR, but to reduce the need for meaningless tasks and to provide adequate compensation which accounts for all of the tasks doctor completes and not only for the face to face encounters.
I want to stress that, at least in our office, replacing paper charts with EMR has improved care of our patients, which in turn made our work even more satisfying. However, we would also love to spend less time doing paperwork.
