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Family Physician EHR Use Outweighs Provider-Patient Interaction

Family docs spend about 54 percent of clinic visits engaging in EHR use rather than interacting with patients.

EHR use among family physicians outweighs time spent interacting with patients.

Source: Thinkstock

By Kate Monica

- Primary care physicians spend more time on EHR use than they spend interacting with patients face-to-face during clinic visits, according to a new study in Family Medicine.

Young et al. conducted a cross-sectional, observational study of family physician attendings, residents, and ambulatory patients during 982 visits in clinics affiliated with 10 residencies of the Residency Research Network of Texas (RRNeT) throughout May and June, 2015. Researchers measured the total visit time, pre-visit EHR charting time, face-to-face patient interaction time, after-hours EHR time, and total EHR work time per visit per physician.

“The purpose of our study was to update measures of the time primary care physicians require to care for ambulatory patients in clinics, to measure how much time was spent working in the EHR, and to determine the other patient, physician, and visit characteristics associated with these time measures,” stated researchers in the report.

Ultimately, researchers found family physicians spent an average of about 18.6 minutes on EHR clinical documentation, compared to about 16.5 minutes interacting face-to-face with patients.

“We found that family physicians spent more time in direct ambulatory patient care working in the EHR than they spent in face-to-face time with their patients,” stated researchers.

Additionally, researchers noted the demands of EHR clinical documentation also contributed to work-life imbalances and cut into providers’ free time.

“The majority of family physicians worked through lunch, stayed late at clinic, or took their work home to complete the day’s EHR work,” researchers wrote.

Researchers stated the study may have financial implications for family physicians.

“The original studies led by Hsiao that led to the Resource-Based Relative Value Scale (RBRVS) used by the Center for Medicare and Medicaid Services to value physician work, were conducted at a time when there was less work performed between visits and before the current evaluation and management (E&M) rules were enacted,” researchers noted.

In these original studies, the amount of time physicians spent not interacting with patients was estimated to comprise about 29 percent of the total visit time. This newest study estimates that figure is closer to about 54 percent of the total visit.

“Furthermore, in the Hsiao’s studies, hypothetical cases based on current procedural terminology (CPT) codes were used,” researchers clarified. “However, there are no CPT codes that describe when a physician addresses more than three issues in a visit, nor are physicians allowed to submit more than one E&M CPT code per day for payment.”

“This implies that the relative value weightings of the CPT codes should be recalculated to increase payment for the significant EHR work time required in today’s primary care,” researchers continued.

 

This is not the first study to suggest physicians spend an inordinate amount of time engaging in EHR use and EHR clinical documentation.

A 2017 study published in the Annals of Family Medicine by researchers at the University of Wisconsin and the American Medical Association (AMA) found primary care physicians spend about 5.9 hours on EHR data entry during a typical 11.4 hour workday.

The amount of time physicians spend at their monitors has contributed to concerns about a work-life imbalance among healthcare professionals. This work-life imbalance may partially account for rising rates of physician burnout.

In an effort to reduce the amount of time physicians spend engaging in EHR use, AMA urged health IT developers to improve EHR usability and prioritize provider satisfaction. AMA outlined eight priorities for health IT developers to consider to boost EHR usability.

For its part, CMS also stated it will prioritize health IT innovation and regulatory relief to ease the burden of EHR clinical documentation for providers.

In a webcast with American Hospital Association (AHA) President and CEO Rick Pollack earlier this year, CMS Administrator Seema Verma outlined how the Patients Over Paperwork and Meaningful Measures initiatives will pare down federal regulations to reduce administrative burden for providers and reduce the likelihood of physician burnout.

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