Nov 252016

Feel like you spend twice as much time on your electronic health record as you do with patients? You may be doing better than half of your colleagues.

In a new work study funded by the American Medical Association, researchers observed 57 physicians in internal medicine, family medicine, cardiology, and orthopedics over hundreds of hours. They discovered that the docs spent almost two hours working on their electronic health record for every one hour of face-to-face patient time. The study was published in Annals of Internal Medicine.

About a third of the participating physicians also kept diaries. Not to record their hopes and dreams, but to document the 1-2 hours of time after hours spent away from their families each night, trying to catch up.

The overall time breakdown was:

  • Interacting directly with patients: 27% of the day
  • Dealing with EHR and other paperwork and pixelwork: 49%
  • Crying in the bathroom*: 26%

One of the study authors noted that it took 32 clicks for her to order and record a flu shot. By the time she was done, flu season was over.

* dramatic embellishments may occur

The study did not stratify the results based on physician age -- but if (as hypothesized) younger docs spend less time clicking, that means their elders are spending even more than these averages. Which makes the 70-ish doc who stood up and walked out of my hospital's EHR orientation and retired on the spot seem pretty smart in hindsight.

Obviously EHRs are here to stay, and have enormous potential advantages, including remote access, more readable notes and being able to quickly(?) locate and synthesize large amounts of information on a patient in one sitting. So why do the available systems suck so badly? I don't know, but here are a few possible reasons:

  • The best and brightest minds in software design don't go to work for Epic, Cerner, Allscripts, and whoever the other ones are.
  • There's a high barrier to entry for competition now that most major health systems have implemented the big-name systems.
  • The vendors can't easily improve the front-end design's user-friendliness (like web pages and consumer software have) because it rests on clunky, proprietary frameworks built in the 1990s and which can't be substantially changed for stability reasons. Think Microsoft Office, but way worse.
  • Software designers are congenitally incapable of accepting the reality that a user would be better off the less they use the product, and designing it that way. They think their EHR is super cool, and can't fathom that it actually sucks to use.

Sadly, electronic health records' soul-draining suction is unlikely to ease up anytime soon. Your only hope may be the AMA, who appear serious about fighting for increased usability of EHRs in the name of physician job satisfaction and quality of patient care. AMA are also probably the only organization who can match the EHR industry's generalized lobbying for the status quo -- which, for example, has been successful at preventing the interoperability of EHRs that was mandated in the Affordable Care Act.

The AMA funded the study, and several of its authors are employed by AMA.

Read more: Allocation of Physician Time in Ambulatory Practice: A Time and Motion Study in 4 Specialties. Ann Intern Med. 6 Sept. 2016.

Associated editorial: Electronic Health Records: An Unfulfilled Promise and a Call to Action

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Life-sucking power of electronic health records measured, reported, lamented