I have posted a number of previous notes about the inefficiencies introduced by EHRs, particularly particularly relating to the fact that their use now constitutes a major time sink for physicians (see: Some of the Major Criticisms of EHRs; Why Few Changes Anticipated; Problems Associated with EHRs: A Medical Malpractice Perspective). A recent article quoted a research study about the time logged by primary care physicians on their EHRs (see: Family doctors spend 86 minutes of “pajama time” with EHRs nightly). Below is an excerpt from it:
A new study using electronic health record (EHR) system event-logging data to track family physicians’ workdays finds that primary care physicians spend more than half of their work day interacting with the EHR—with nearly a quarter of that computer work happening after clinic hours. Yet, physician experts argue, a big chunk of the administrative work family physicians and other doctors do on EHRs could be properly delegated to other members of the practice team....Over a three-year period, all Epic...EHR interactions from 142 family physicians in a single health care system in southern Wisconsin were captured from “event logging” records, used to monitor performance of the system. The tale of all that tape is that each weekday, physicians spent an average of 5.9 hours out of an 11.4-hour workday working in the EHR. That consisted of 4.5 hours during clinic times and 1.4 hours after work. Clerical and administrative tasks such as documentation, order entry, billing and coding and system security, accounted for 44 percent of the total EHR usage time. About one-third of the time was spent on medical care EHR tasks such as chart reviews and problem lists, while inbox management took up 24 percent of family physicians’ time.
[A co-author of the study said]: “Work previously done by other team members has been shifted to the physician in the EHR,”....Tasks that may have earlier required a matter of seconds, now may each take one to two minutes. Add this up over the thousands of individual tasks each day and it wasn’t surprising that I and other physicians began to wonder if we were spending more time caring for the computer than caring for the patient....The data from the Wisconsin family physicians’ event logs buttress the findings in a direct-time motion observation study....which found that for each two hours physicians spend on direct patient care, they spend one hour wrestling with EHR tasks.
The conclusion of this article is that primary care MDs spend about half of their work days logged on their EHRs including a significant portion of time at home. The conclusion is inescapable that EHRs are digging deeply into the "face time" that physicians should be spending with patients. These inefficiencies attributable to EHRs are well known to hospital executives. In response, they have begun hiring medical scribes to support some physicians, a topic about which I have blogged about extensively (see, for example: Greater Adoption of the Scribe Model for EMR Data Input; The Explosive Growth of EHR Scribes; Back to the Future).
Here's the catch, though, regarding scribes. Hospitals generally assign them to those medical specialists who generate the most revenue for the hospital. This boils down to the fact that they are hired to assist medical specialists. This leaves the primary care physicians, whose time drain due to the EHRs is addressed above, out in the cold. Medical scribes are also difficult to recruit and retain. Many of them intend to attend medical or nursing school and sign-up for scribe jobs for only a limited amount of time.
We need to now ask the question of why hospital executives tolerate the time drain imposed on some of their most valuable employees. The answer is certainly that they see no alternative. They can't deinstall their EHRs which are now viewed as mandatory. They can't press their EHR vendors to improve the design of the systems. Hospitals are now a captive market for EHRs with the vendors functioning as quasi-monoplyies. The systems themselves are large, monolithic, and difficult to change at a fundamental level. The executives simply tolerate the fact that their PCP employees operate less efficiently and bake the cost of these inefficiencies into the cost of care which is then borne by patients, health insurance companies, and governmental agencies. However, health insurance companies are now directing more business to health facilities that offer lower cost care (see: Anthem Won't Pay for Outpatient MRIs and CT Scans in Hospitals).