How Much Time Do EHRs Eat Up?

It’s common to hear healthcare providers and other industry figures grumble about how electronic health records consume too much of their time. But studies that back up that concern come around less often.

Enter a new report published yesterday in JAMA Ophthalmology. Not only did it measure the amount of time taken up by EHRs, but it also confirmed the backbone of that complaint, at least for ophthalmologists.

“Ophthalmologists have limited time with patients during office visits,” the Oregon Health & Science University researchers wrote, “and EHR use requires a substantial portion of that time.”

The authors observed 27 of the specialty doctors from 2013 to 2016, according to the study. During patient visits, the research team recorded time-motion data from the participants, looking for EHR use, conversation, and examination. When the ophthalmologists talked with patients while diving into medical records, that action was filed as EHR use. The researchers also analyzed time stamps from records and the audit log, a cache of quality data.

On average, the providers spent 11.2 minutes with each patient. Of that, 27% went to EHR use, 42% to discussion, and 31% to examination, according to the study. For each encounter, the mean time spent using EHRs totaled 10.8 minutes, or 3.7 hours per day, including 2.1 hours during patient visits and 1.6 hours outside the clinical setting, the researchers wrote.

But, they noted, the time spent on EHRs varied from one ophthalmologist to another.

Further analysis revealed that each additional patient encounter corresponded with 1.7 minutes less in the EHR per visit for participants with high billing levels, according to the study.

The study follows several similar ones that dredged up conflicting results. It also comes at a time when EHR use is becoming ubiquitous, with 74% of US medical offices in 2014 having such a system and more than 95% of acute care hospitals in the same boat, according to various studies. What’s more, the researchers said, the “growing complexity and documentation” in healthcare has worsened the situation.

“Physicians are pressured to see more patients in less time because of challenges involving accessibility and cost of care,” they wrote.

Despite the results, the authors cautioned readers to not leap to conclusions about the level of EHR use confirmed in the study.

“The purpose of this study was to analyze the amount of time clinicians spent using the EHR, not to determine its positive or negative outcomes,” they noted. “Although studies have shown that the nature of EHR documentation is different from paper documentation, the overall association of EHRs with quality of care warrants further study.”

Still, EHRs have changed how physicians interact with their patients, the researchers said. The technology could ultimately elevate care, it creates “clerical and cognitive burdens, bloated records with copied and pasted text, and frequent interruptions that threaten the potentially beneficial outcomes,” the team wrote. The systems are also on the rise at a time of increasing burnout among physicians.

Taken together, the findings emphasize the need for more—and more varied—research, according to the study.