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The Financialization of US Health Care Is Responsible for the EHR Burden on Clinicians

Assessment of Electronic Health Record Use Between US and Non-US Health Systems
JAMA Internal Medicine  2021;181(2):251-259.
February 1, 2021
A. Jay Holmgren et al. 


From the Abstract: 

Design, Setting, and Participants: This cross-sectional study analyzed the deidentified metadata of ambulatory care health systems in the US, Canada, Northern Europe, Western Europe, the Middle East, and Oceania from January 1, 2019, to August 31, 2019. All of these organizations used the EHR software from Epic Systems and represented most of Epic Systems’s ambulatory customer base.

Results: US clinicians spent more time per day actively using the EHR compared with non-US clinicians (mean time, 90.2 minutes vs 59.1 minutes; P < .001). In addition, US clinicians vs non-US clinicians spent significantly more time performing 4 clinical activities: notes (40.7 minutes vs 30.7 minutes; P < .001), orders (19.5 minutes vs 8.75 minutes; P < .001), in-basket messages (12.5 minutes vs 4.80 minutes; P < .001), and clinical review (17.6 minutes vs 14.8 minutes; P = .01). Clinicians in the US composed more automated note text than their non-US counterparts (77.5% vs 60.8% of note text; P < .001) . . . . The median US clinician spent as much time actively using the EHR per day (90.1 minutes) as a non-US clinician in the 99th percentile of active EHR use time per day (90.7 minutes) in the sample. These results persisted after controlling for organizational characteristics, including structure, type, size, and daily patient volume.

Comment by David Himmelstein and Steffie Woolhandler

US clinicians complain bitterly about their documentation burden and unwieldy EHRs that sap the joy of patient care, and these burdens are a main cause of the widespread and growing burnout problem.  This study makes clear that the US payment system inflicts much of this burden.  In other nations, clinicians using EPIC – the most widely used EHR in the US – spend far less of their time staring at computer screens and checking the endless boxes needed to assure payment.  A single payer reform that simplifies payment would greatly improve clinicians’ work lives.    

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