09 Jul Internists and Family Practitioners Spend Hours Daily on Electronic Records and Messages
MedicalResearch.com Interview with:
Lisa Rotenstein, MD, MBA
Assistant Medical Director
Population Health and Faculty Wellbeing
Department of Medicine
Brigham and Women’s Hospital
MedicalResearch.com: What is the background for this study?
Response: Our previous work in JAMA Internal Medicine demonstrated significant differences in time spent on the electronic health record (EHR) by specialty, and specifically showed that primary care clinicians spent significantly more total and after-hours time on the EHR than surgical and medical specialty counterparts. Primary care clinicians spent twice as long as surgical colleagues on notes, and received more than twice as many messages from team-mates, five times as many patient messages, and fifteen times as many prescription messages each day.
Given these findings, the heavy administrative burden placed on primary care clinicians, and previous data about burnout among primary care clinicians, we wanted to better understand differences in time spent on the EHR among the different types of primary care clinicians.
MedicalResearch.com: What are the main findings? Does patient access to their records encourage more/less electronic interactions with their provider?
Response: We found that general internal medicine and family medicine clinicians spent significantly more total and after-hours time on the EHR than pediatric counterparts.
Pediatric clinicians spent approximately half as long on in-basket messages as compared to family medicine and general medicine clinicians, and two-thirds as much time on clinical review and orders. They received one-third as many patient messages, one-half as many team messages, less than one-half as many results messages.
Notably, time spent on notes was comparable among all the primary care specialties, making this an area ripe for innovations.
MedicalResearch.com: What should readers take away from your report? Should patient messaging or scribes be covered services?
Response: Our findings highlight an opportunity to streamline the EHR experience across functions – notes, in-basket, orders – for general internal medicine and family medicine clinicians. The time they are spending on these functions is time they could be spending interacting with patients and families, which would enhance the patient experience.
Our study additionally underscores that there is an opportunity to streamline the notes function across primary care specialties. This is where scribes come in, and certainly, coverage for scribes (including virtual or AI scribes), could help alleviate the burden of documentation.
In addition to its implications for the patient-clinician experience, our study has important implications for clinician wellbeing. Increased time on the EHR is associated with clinician burnout, and we know that burnout has consequences for quality of care and outcomes, in addition to its important consequences for individual clinicians.
MedicalResearch.com: What recommendations do you have for future research as a result of this work?
Response: Future research can help us answer what types of technologies and organizational innovations lessen the time burden of the EHR, and particularly of notes. They can help us learn about what kinds of EHR configurations and team arrangements could reduce the burden of in-basket messaging, without compromising the patient experience.
There are also important questions to be answered about the effects of open notes and new E&M documentation requirement changes on EHR use patterns.
Disclosures: Dr. Rotenstein reports being an owner of CareZoom, outside the submitted work.
Rotenstein LS, Holmgren AJ, Downing NL, Longhurst CA, Bates DW. Differences in Clinician Electronic Health Record Use Across Adult and Pediatric Primary Care Specialties. JAMA Netw Open. 2021;4(7):e2116375. doi:10.1001/jamanetworkopen.2021.16375
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