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Electronic Health Records (EHRs) Cost Nurses and Physicians Time with Patients

September 26, 2017:

There are several benefits of adopting EHRs —better communication and collaboration among providers, continuity of care, increased patient safety, reduction in medication errors, and increased efficiency. Being more efficient usually means more time is freed up to devote to patient care. However, several studies have found that some providers are finding that with EHRs, they have less, not more, time to spend with patients.

A literature review from 2005 provides a good snapshot of what expectations were 10 years ago of EHR’s impact on time efficiency. The review, titled “The Impact of Electronic Health Record on Time Efficiency of Physicians and Nurses: A Systematic Review” and published in the Journal of the American Medical Informatics Association, looked at 23 papers on time efficiency and EHRs. It concluded that, though some had hoped EHRs would reduce workloads of nurses and physicians, the new technology actually increased documentation time per patient. Nurses were spending anywhere from 7.7 percent to 128.4 percent more time documenting per patient, and physicians 8.2 percent to 17.5 percent depending on whether the terminal was at a central station or bedside. For physicians, computerized physician order entry (CPOE) at a central station increased documentation time by a weighted average of 238.4 percent.

Although documentation time per patient had increased, nurses were spending about 24 percent less time on documentation per shift when using EHRs. Physicians saw no such time benefit per workday.

The studies reviewed found that, whereas physicians and nurses reported spending slightly less time on documentation within three months of EHR implementation, this effect wore off over time. The review authors postulated that as physicians learned and took advantage of the full functionality of EHRs, they spent more time on the records.

Where efficiencies were found was at the organization level in terms of accessing patient charts and maintaining report forms. The entire process of creating, maintaining, and retrieving health records was more efficient overall.

Recent studies indicate that, more than 10 years later, most physicians and nurses still find that EHRs do not enable them to spend more time with patients. An HIMSS Analytics survey conducted in 2015 for Allscripts assessed nurses’ experiences with electronic records. Of the more than 600 respondents, only 43 percent agreed that EHRs eliminate duplicate work. Even fewer—31 percent—reported that EHRs help them spend more time with patients.

Physician time seems to be much harder hit by the EHR than nurse time. A study published in the September/October issue of Annals of Family Medicine notes that for every hour a primary care physician spends with a patient, he or she spends two hours on tasks related to EHRs. The study, conducted by the University of Wisconsin and American Medical Association, looked at more than 118 million EHR events of 142 physicians over three years. It found that each clinician spent nearly six hours of an 11-hour workday on EHR tasks. Two and a half of those six hours were spent on clerical and administrative tasks such as documentation, order entry, billing and coding, and system security. Documentation alone took up 84 minutes per day, and coding took up 14 minutes.

Authors of the study cite statistics showing that half of U.S. physicians report feeling burned out with increased pressure to beef up documentation, complete CPOE, manage inboxes and patient portals, and assume tasks previously performed by clerical staff.

It is clear that EHRs, while benefiting the overall process of record creation and maintenance, can drain time spent actually providing care and lead to clinician burnout. The authors of the Annals of Family Medicine study suggest some ways to ease the time burden on physicians: using voice recognition software or transcription services; employing alternatives to CPOE, which minimal evidence indicates increases patient safety; and building more face-to-face, rather than written, communication among clinicians into the day. Noting that physicians appear to be performing tasks that could be performed by clerical staff, the authors also advise that physicians delegate some of their EHR-related work.


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