US physicians spend many hours daily interacting with electronic health record (EHR) systems. This contributes to work-life imbalance, dissatisfaction, professionals leaving medicine, and a burnout rate of 50 percent.
While the problem is complex, time spent on computers doing administrative tasks is a leading cause of frustration. A recent three-year study from the University of Wisconsin found that the average family physician spent nearly six hours in the EHR daily. Even more troubling – if not surprising – is that nearly 90 minutes of the doctors’ daily EHR dose was after hours.
As a physician, you probably aren’t shocked by these findings. But you probably are clear that you didn’t study medicine so you could spend extra hours at home on documentation, order entry, billing, coding and email.
So how can physicians reduce after hours EHR time?
The Wisconsin study authors suggest five solutions for primary care physicians, each of which requires thoughtful EHR system application:
- Proactive planned care
- Team-based care that includes expanded rooming protocols, standing orders, and panel management
- Sharing of clerical tasks, including documentation, order entry, and prescription management
- Verbal communication and shared inbox work
- Improved team function
These solutions follow naturally from the study’s finding that two-thirds of physician computer time was allocated to clerical and inbox work. As the authors write, these types of EHR-related tasks “could be delegated, thereby reducing workload, improving professional satisfaction, and reducing burnout.
Technology solutions and real-time documentation are two related interventions that can help physicians reduce after hours EHR time.
Jane Fogg is chair of internal medicine and population health at Atrius Health in Newton, Massachusetts. As Fogg told Physicians Practice, Atrius Health found that minor technology and workflow changes created real efficiencies for their doctors.
For example, in many EHR systems physicians receive lots of information in their inbox. Messages include everything from patient questions, referral requests, and updates from specialists.
While some of these messages require attention, others simply inform doctors that a patient’s status hasn’t changed. Realizing that doctors spend hours in their inbox each day, Fogg worked with the heads of clinical departments to ensure that primary-care physicians only get updates if there’s a negative result or a significant medication change for their patients.
Similarly, Atrius Health found that primary care physicians were getting too many notifications for each patient visit. They re-designed their system to consolidate these notifications into a single dashboard where physicians can check a patient’s status.
These types of simple technology solutions can optimize EHR use and make more efficient use of physicians’ time. While doctors should pursue ongoing training in their chosen EHR system, they also need support from practices to be more efficient.
Dr. Mark Casillas is an orthopedic surgeon who has embraced automated dictation at his practice in San Antonio. Casillas uses Mobius Scribe, a medical-grade dictation software, to dictate notes on his iPhone. Scribe immediately syncs with the EHR, so Casillas completes most of his clinical documentation during the patient encounter.
“I like dictating the history, physical exam and my plan in front of the patient,” Casillas explains, “because I can pause and ask them, ‘Is there anything I should have added or emphasized?’ They like to hear that I can dictate everything, and for me it’s a matter of convenience that it’s all documented.”
Whether it is real-time documentation or another solution, physicians should decide on an efficient medical transcription workflow. Streamlining clinician documentation is an important way to shave off after hours EHR time.