The primary care EHR tune-up

Primary care didn’t suddenly become “digital.” It entered an always-available mode of care.

In one academic system, researchers tracking electronic health record (EHR) activity found that physicians spent more time in the record in 2022 and 2023 than before the COVID-19 pandemic, with measurable increases in inbox time and a sharp rise in portal-based advice requests. The same analysis pointed to a familiar pressure point: policy and product decisions — such as immediate release of test results — can shift patient questions forward in time, sometimes landing in the message queue before the clinician has even seen the result.

The result is an EHR that behaves less like a chart and more like a work distribution engine. When documentation expands, it doesn’t just take time; it crowds out other high-value tasks and compresses the day.

In a conversation with Medical Economics, University of Chicago physician and assistant professor of medicine Justin Porter, M.D., put a label on what many clinicians experience: “Any clinician can attest to a lot of bloat in the amount of paperwork we need to do for patients … that tends to come through the [EHR].”

Clinicians aren’t guessing about the tradeoffs.

In the American Medical Informatics Association’s (AMIA’s) 2024 TrendBurden survey, 80% of physician respondents agreed that the time required to complete documentation impedes patient care.

The good news, if it qualifies as that, is that some of the most effective fixes look almost boring.

University of Michigan researchers found that clarifying team roles and message routing, without new technology or added cost, reduced monthly messages per full-time physician and cut “carbon copy” noise dramatically. The lead author, Nicole Hadeed, M.D., summarized the idea: “Focusing on getting the right message to the right place the first time was a simple and powerful intervention.”