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On a typical day, a physician spends nearly two hours on documentation for every one hour seeing patients, according to a study published on September 6, 2016, in the Annals of Internal Medicine. The study involved direct observations of 57 physicians in ambulatory care settings in four states during a period between July 7, 2015, and August 11, 2016. On average, the authors said, a doctor spends 27% of his or her work day on direct clinical contact with patients and 49.2% on electronic health record (EHR) and desk work. Even while in the examination room, the authors said, a physician spends 52.9% of his or her time directly interacting with the patient and 37% on documentation. The 21 physicians who included after-hours reports said they worked an additional one to two hours per night, mostly on EHR-related tasks. The physicians were distributed across family medicine (12 participants), internal medicine (19 participants), cardiology (11 participants), and orthopedics (15 participants). The authors said their findings were in line with previous studies that suggested physicians are spending less time treating patients and more time working with the EHR. The authors posited that workload from EHR tasks has led to increasing professional dissatisfaction among physicians, which they said could be associated with the rapid increase in physician burnout rates between 2011 and 2014. Sharing documentation tasks through dictation or documentation assistant services could increase the clinical face time physicians spend with patients, the authors said. They cautioned that their findings are limited because the study was small and self-selecting, and the doctors could have changed their behavior knowing they were being observed. There was also no way to tell how much time a physician spent on record keeping before the advent of EHRs. The authors concluded that their results should not be taken as "good or bad"; the conclusions, they said, "needs to be linked to quality, financial, and professional satisfaction outcomes for a full understanding of the activities that are critical to achieving superior clinical outcomes versus the activities that are required only for administrative and regulatory purposes or that represent a source of inefficiency or a waste of time, talent, or resources."

HRC Recommends: Although the promise of health information technology (IT) to improve patient safety and healthcare delivery is great, so too are risks of jeopardizing care if organizations fail to address risks throughout the life cycle of any health IT project. Maximizing benefits while identifying unintended consequences and ensuring safe use is an ongoing imperative for all healthcare organizations. ECRI Institute is among the organizations promoting multidisciplinary learning from health IT events through the Partnership for Health IT Patient Safety. Health IT configurations and workflow that do not support each other also represent one of ECRI Institute's top 10 patient safety concerns for 2016. Beyond the potential for health IT to contribute to patient safety incidents, inadequate integration of health IT use and clinical workflow, as well as poor design, may negatively affect the quality of the patient–provider interaction and lead to inefficient use of providers' time. Healthcare organizations may wish to undertake systems analyses of health IT use to identify concerns and potential strategies.

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Health Information Technology; Quality Assurance/Risk Management

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Publication History

​Published September 14, 2016

Who Should Read This

​Cardiology, Chief medical officer, Health information management, Information technology, Outpatient services, Patient safety officer, Quality improvement, Risk manager