Doctors split time nearly evenly between patients, computer duties
Doctors spent 3.08 hours for face-to-face visits and 3.17 hours for computer activities related to patient care.
An analysis of doctors' electronic health record (EHR) habits showed that they are nearly evenly splitting their time between face-to-face patient encounters and computer use.
Researchers used the time-stamp function of an electronic health record (EHR) to examine physician-patient interactions and the computer work required to support them. “Desktop medicine” activities included communicating with patients through a secure patient portal, responding to online requests for prescription refills or medical advice, writing progress notes, ordering tests, sending staff messages, and reviewing test results.
The study used 31 million EHR transactions involving 471 physicians in 48 primary care departments of four divisions of a community-based health care system that treated 765,129 patients from 2011 through 2014. The study calculated the average daily sum of each physician's “in and out of clinic time” that could be assigned to specific patients. Results appeared in the April Health Affairs.
To estimate the length of a face-to-face ambulatory care visit, researchers recorded the time of the first EHR transaction and the time of the last EHR transaction for that patient in an exam room. This methodology was verified by comparing the EHR logins with in-person observations and with audio recordings of the encounter. On average, the log-based estimates were two minutes shorter than those based on in-person observation and three minutes shorter than those based on audio recordings. In addition to exam-room encounters, researchers tallied the logins from physicians' clinic desktop computers, as well as secure remote computers or other secure devices.
The average daily total logged time was 3.08 hours for face-to-face and 3.17 hours for desktop medicine. On average, 15.0 (SD, 10.7) minutes were recorded for a face-to-face visit in the exam room. Of the time spent on desktop medicine, an average of 2.82 hours was spent in the clinic, with 1.42 hours spent on patients who were seen on the same day and 1.40 hours spent on other patients. An average of 0.35 hour was spent on secure remote computers, 0.14 hour for patients who were seen on the same day and 0.21 hour for other patients.
The primary desktop medicine activity both in the clinic and remotely was typing progress notes. Other desktop medicine activities, in descending order of time spent, were logging telephone encounters, exchanging secure messages with patients, and refilling prescriptions. Common desktop medicine activities for patients not seen that day were orders for services, chart reviews, letters for external use, and scanned documents.
The logs suggest that physicians allocate equal amounts of their clinically active time to desktop medicine work and to face-to-face ambulatory care visits, the researchers noted.
“While working on progress notes could be considered pre- or post-service efforts, desktop medicine activities not linked to a face-to-face visit are not reimbursable under typical fee-for-service contractual and regulatory arrangements,” the authors wrote. “Many of those activities—such as care coordination and responding to patients' e-mail—are of high value to the delivery system and to patients, so the staffing, scheduling, and design of primary care practices should reflect this value.”