Research published online tonight in Annals of Internal Medicine shows what doctors already know – EHRs, or electronic health records, are causing physicians to burn out.
Although the study was small – 57 physicians from four states – it showed that they spend almost twice as much time maintaining patients’ electronic health records as they do face to face with the patient.
The study was funded by the American Medical Association and looked at doctors in family practice, internal medicine, cardiology and orthopedics. They practiced in Illinois, New Hampshire, Virginia, and Washington. The study used direct observations as well as self-reported diaries (for time spent working after office hours).
“During the office day, physicians spent 27 percent of their total time on direct clinical face time with patients and 49.2 percent of their time on HER and desk work,” according to the study abstract. “While in the examination room with patients, physicians spent 52.9 percent of their time on direct clinical face time and 37 percent on EHR and desk work. The 21 physicians who completed after-hours diaries reported one to two hours of after-hours work each night, devoted mostly to EHR tasks.”
While I would not consider these findings particularly newsworthy in and of themselves, the topic of EHRs and doctor burnout in general is a hot one. One of the most interesting stories I ever reported during my three years at Healthline, at least to me, was a story headlined, “Is technology costing doctors time with their patients?” You can read it by clicking here.
From Google Glass to information overload
I had the pleasure of interviewing Dr. John Halamka, chief information officer at Beth Israel Deaconess Medical Center in Boston, who at the time also served on Healthline’s medical advisory board. He explained that at Beth Israel Deaconess, ER doctors use Google Glass.
When they enter the exam room, the glasses they are wearing scans a bar code on the wall. “Instantly, the patient’s medical information appears in the doctor’s line of vision, and he or she can refer to it while examining and speaking with the patient,” I wrote.
Pretty cool. Of course, Google Glass-wearing doctors are not yet the norm.
He talked about his father dying in the ICU of a Los Angeles Hospital, yet, even with all the data EHRs can collect, “Nobody could tell me how my father was doing.”
At the same time, when his wife was diagnosed with breast cancer, he was able to comb data from 10,000 patients with similar diagnoses to determine the best treatment for her. Of course, not everyone is an IT director at a hospital and has such access, he admitted.
He said then that when it comes to the EHR, “We are in the biplane era. We haven’t invented the jet engine yet, but we’re not in the era of the Wright brothers either.”
Time to stop complaining, start doing, editorial says
In an editorial accompanying the Annals research, Dr. Susan Hingle of the Southern Illinois University School of Medicine, Springfield, said, “Now is the time to go beyond complaining about EHRs and other practice hassles and to make needed changes to the health care system that will redirect our focus from the computer screen to our patients and help us rediscover the joy of medicine.”
I suspect both patients and doctors will agree with that. And organizations such as the American Medical Association and American College of Physicians have various initiatives working toward that goal.
“Many studies have documented lower patient satisfaction when physicians spend more time looking at the computer and performing clerical tasks,” Hingle wrote. “Patient satisfaction can affect health outcomes via adherence to the care plan and can also affect physician and hospital reimbursement, so the stakes are high.”