Hours spent record-keeping may fuel physician burnout

(2010 Chris Schmidt)

For every hour doctors spend treating patients during a typical workday, they devote nearly two more hours to maintaining electronic health records (EHR) and clerical work, a small U.S. study suggests.

Time spent in meaningful interactions with patients is a powerful driver of physician career satisfaction, but increased paperwork and time on the computer means less time for direct patient care, the authors argue.

"When you take people who were trained to be caregivers and put them in the role of being a technician documenting their work, there is bound to be a loss of joy and work satisfaction," Dr. Susan Hingle of the SIU School of Medicine in Springfield, Illinois, told Reuters Health by email.

While the goal of electronic health records is to improve the quality and efficiency of patient care, the findings suggest that in reality, EHRs are taking time away from physicians' interactions with patients and families, said study leader Dr. Christine Sinsky, vice president of professional satisfaction at the American Medical Association.

"Many physicians have voiced concerns that the cumulative effect of the many well-intended efforts has been, paradoxically, to make it harder for them to deliver quality of care," Sinsky said by email.

To get a snapshot of how electronic record keeping impacts the way doctors spend their time, Sinsky and colleagues analyzed data collected on 57 physicians in four U.S. states.

The physicians worked in family medicine, internal medicine, cardiology and orthopedics in Illinois, New Hampshire, Virginia and Washington.

Researchers looked at work activities two ways: medical students directly observed the tasks physicians completed, and a subset of doctors also filled out work flow diaries.

At least half of the doctors in the study were observed for at least eight hours.

Roughly half of the participants had tools such as dictation support services or documentation-assistant services to help with EHRs.

Overall, the physicians spent 27 percent of their time interacting directly with patients and 49 percent of their time on EHRs and desk work, the study found.

The time spent on electronic paperwork was divided between documentation and review tasks, and ordering drugs or other things needed for patient care.

Doctors did spend about 48 percent of their time in exam rooms, though only a little more than half of this time involved direct face time with patients. Roughly 37 percent was devoted to EHRs and desk work.

Outside office hours, physicians spent another one to two hours of personal time each night doing additional clerical work.

One limitation of the study is that patients could opt out of observation, making the snapshots of workflow incomplete, the authors note in the Annals of Internal Medicine. Researchers also didn't track the number of patients seen per hour, the complexity of patients treated or the work activities of support staff.

Even so, the authors conclude that physician burnout may become more likely when doctors get less time to spend treating patients.

Efforts to reduce administrative burdens and give doctors more time to spend with patients may make it easier for physicians to focus directly on providing care and help reduce the potential for burnout, Hingle wrote in an editorial published with the study.

"I think that technology needs to be changed so that it is more user friendly, less burdensome, and returns the focus to the patient's story, rather than minute details that don't really impact patient satisfaction or outcomes," Hingle told Reuters Health.