16 minutes EHR time per ambulatory patient? Get real!
January 24, 2020
Topics: Quote of the Day
By J. Marc Overhage, M.D., Ph.D. and David McCallie Jr., M.D.
Annals of Internal Medicine, January 14, 2020
Abstract
Background: The amount of time that providers spend using electronic health records (EHRs) to support the care delivery process is a concern for the U.S. health care system. Given the potential effect on patient care and the high costs related to this time, particularly for medical specialists whose work is largely cognitive, these findings warrant more precise documentation of the time physicians invest in these clinically focused EHR functions.
Objective: To describe how much time ambulatory medical subspecialists and primary care physicians across several U.S. care delivery systems spend on various EHR functions.
Design: Descriptive study.
Setting: U.S.-based, adult, nonsurgical, ambulatory practices using the Cerner Millennium EHR.
Participants: 155,000 U.S. physicians.
Measurements: Data were extracted from software log files in the Lights On Network (Cerner) during 2018 that totaled the time spent on each of the 13 clinically focused EHR functions. Averages per encounter by specialty were computed.
Results: This study included data from approximately 100 million patient encounters with about 155 000 physicians from 417 health systems. Physicians spent an average of 16 minutes and 14 seconds per encounter using EHRs, with chart review (33%), documentation (24%), and ordering (17%) functions accounting for most of the time. The distribution of time spent by providers using EHRs varies greatly within specialty. The proportion of time spent on various clinically focused functions was similar across specialties.
Limitations: Variation by health system could not be examined, and all providers used the same software.
Conclusion: The time spent using EHRs to support care delivery constitutes a large portion of the physicians’ day, and wide variation suggests opportunities to optimize systems and processes.
Epic’s CEO is urging hospital customers to oppose rules that would make it easier to share medical info
By Christina Farr
CNBC, January 22, 2020
Key Points
- Epic Systems is urging its health system customers to take a stand against the U.S. Department of Health and Human Services’ proposed rules to make it easier to share patient data.
- Epic’s CEO Judy Faulkner says that patient privacy will be negatively impacted.
- Privately held Epic is one of the leading providers of electronic medical records in the U.S.
Comment:
By Don McCanne, M.D.
Ambulatory primary care physicians and medical subspecialists spent an average of 16 minutes and 14 seconds per encounter using EHRs, with chart review (33%), documentation (24%), and ordering (17%) functions accounting for most of the time. Those physicians who try to see four patients an hour understand that this does not compute.
In my earlier years of general practice (before I became a charter diplomat in the new field of family practice), only one of our four hospitals existed, and the emergency room was not staffed (we rotated call to cover it from our individual practices). My brother and I each scheduled four patients and averaged about two walk-ins per hour (unavoidable because of the acute nature of our practice – problems that are now usually seen in the emergency room or urgent care centers).
Obviously medical records were a problem. We had to record notes quickly yet adequately. How did we do that? A few years later Lawrence Weed developed the problem oriented medical record. He proselytized on SOAPing the records – recording the organized elements of subjective, objective, assessment, and plans. Intuitively I was already doing that, but without the S,O,A,P designations. It worked very well. It took maybe a minute to record the note, and there was always enough recorded for continuity of care. Also my records were never questioned for lack of adequacy.
So why do we need electronic health records? To make it easier for insurers to deny claims? For entrepreneurial entities to collect and sell data to other enterprises to profit off of patient and provider information? To violate the patients’ privacy? And for what reason?
Even EPIC’s Judy Faulkner says that under HHS rules making it easier to share patient data patient privacy will be negatively impacted. Do we really want to go there?
Surely we can find things to do with 15 of those 16 minutes that will better serve the interests of our patients.
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About the Commentator, Don McCanne
Don McCanne is a retired family practitioner who dedicated the 2nd phase of his career to speaking and writing extensively on single payer and related issues. He served as Physicians for a National Health Program president in 2002 and 2003, then as Senior Health Policy Fellow. For two decades, Don wrote "Quote of the Day", a daily health policy update which inspired HJM.
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