The patient encounter doesn’t end when the patient walks out the exam room door. Those are words no primary-care physician needs to hear, but it represents reality.
Most physicians are not just documenting the patient visit in the EHR, but approving prescription refills, reviewing labs, responding to patients’ questions via the patient portal, keeping tabs on diagnoses from referring physicians, and managing the overall health of their patient panel.
Primary-care physicians are hit the hardest by excessive EHR time because of the nation’s transition to value-based care, where they act as the “quarterback” of the care team. In that role, they also serve as the default physician contact for updates on all the patients in their panel, says Jane Fogg, chair of internal medicine and population health at Atrius Health, a Newton, Mass.-based health system.
Fogg says the clinicians on her team are often logged into the EHR at 5 a.m. and don't log off until the late evening hours.
A recent study in the Annals of Family Medicine found that physicians were spending nearly six hours a day in the EHR — nearly 90 minutes of which is spent after clinic hours and often at home, which they dubbed "pajama time." The study included examining 142 physicians over three years and recommended that some of the work docs are doing in the EHR could be delegated to other staff members.
Specific recommendations by the study’s authors include:
• Proactive planned care
• Team-based care that includes expanded rooming protocols, standing orders, and panel management
• Sharing of clerical tasks, including documentation, order entry, and prescription management
• Verbal communication and shared in-box work
• Improved team function
The study’s finding that physicians were spending two hours in the EHR for every hour they were spending with patients was no surprise to Fogg. While she encourages physicians to pursue ongoing training in the EHR, she says they really need the support of their practice in order to be more efficient. Specifically, Atrius Health has undergone several initiatives to help physicians achieve this EHR optimization.
• Smarter inbox management. The physician’s inbox is where they receive questions from patients and referral requests and updates from specialists. Until recently, all of the updates from specialists arrived in the primary-care physician’s inbox at Atrius Health, and that was the case whether it was just a message informing the doc that their patient was fine or if there was something problematic.
All of those updates informing primary-care physicians that their patients’ status is unchanged are effectively taking over physicians’ inboxes, and they don’t deliver clinical value, says Fogg.