- Ambulatory physicians spent more time working in the electronic health record, including time outside patient scheduled hours, and sent a higher volume of patient messages following the onset of the COVID-19 pandemic, according to a study published in JAMA on Monday.
- The increase in time that physicians spent in EHRs and documenting patient visits was significantly associated with the shift to telemedicine, which increased from 3.1% of medical visits to 49.3% of visits from August 2018 to September 2021.
- For every eight hours scheduled with patients, physicians spent five or more hours working in the EHR. Researchers from the study urged health systems to “consider the burden of EHR time for physicians,” noting that documentation burden has been linked to employee burnout.
At the onset of the pandemic, healthcare delivery rapidly shifted to digital settings, as providers were forced to transition from face-to-face encounters to virtual care models nearly overnight. Although the public health emergency has now been lifted, patients — particularly those in younger generations — continue to express sustained interest in telemedicine.
Providers now routinely manage hybrid case loads including in-person and virtual care appointments, and physicians may have additional documentation tasks embedded in their workflows, the report found.
The report studied EHR use and patient messaging among 1,052 ambulatory care physicians at University of California San Francisco Health to determine how much the shift to telemedicine has increased providers’ documentation tasks, particularly those done outside of working hours.
Time spent working in the EHR during patient service hours increased from 4.5 hours to 5.5 hours per eight patient scheduled hours, or PSHs. Physicians also experienced increased EHR workloads outside of working hours, with documentation times strongly associated with physicians’ use of virtual care.
While physicians may be spending more time in the EHR during virtual care appointments, due to its integration with virtual platforms, researchers said that alone does not account for the hours physicians spend on documentation outside of PSHs.
The researchers said that appointment adherence improved as a result of telehealth, and as a result providers often saw patients back-to-back, reducing the time available to document the visit. As a result, EHR tasks may carry into unscheduled hours.
“It may also be that telemedicine requires more before-visit EHR review in the absence of a physical examination, or a non-physician staff member communicating the patient’s medical history verbally,” the researchers said.
The study also found patient messages to physicians increased from an average of 16.8 to 30.3 messages sent per week and physician messages increased from 13.8 to 29.8 messages per week. However, physician-initiated cold messages significantly decreased in weeks when clinicians were working primarily virtual care appointments.
“It is hard to know whether the reduction in physician-initiated cold messages to patients is encouraging or worrisome,” the researchers said. “It may be that cold messages are not needed because of good matching… However, it could be that the increased EHR burden limits physician time for cold messages regarding follow-up visits and outreach, with potential implications for quality of care.”
The study recommended healthcare operators invest in supportive technology such as virtual scribes or adapt workflows to allow other staff to move patients into a virtual waiting room.
Spotting demand, recently, several major technology players have attempted to cut in on the virtual scribe market, offering solutions that they say will cut down on physicians’ documentation burden. Amazon, Google and Microsoft are developing versions of the product, while hospital chains such as HCA Healthcare are attempting to create their own products in-house.