Physicians lose about 48 minutes of free time per clinic day through their interaction with EMRs, according to a study published online in a research letter in JAMA Internal Medicine.
The study evolved out of a 19-question survey sent out by the American College of Physicians (ACP) in December 2012 that yielded 411 responses from practicing physicians and trainees who worked in an ambulatory practice and used EMRs.
According to the study, led by Clement J. McDonald, MD, of the Lister Hill National Center for Biomedical Communications, the respondents were for the most part experienced EMR users, with 82 percent reporting that they had EMRs in their practice for more than a year.
Eighty-nine percent of respondents reported at least one data management function was slower post-EMR adoption, while 63.9 percent reported that note writing took longer. About one-third (33.9 percent) said it took longer to find and review medical record data with the EMR and 32.2 percent said it took longer to read other clinician’s notes with the EMR.
The researchers found that the mean time loss for attending physicians was 48 minutes per clinic day or about four hours per week. The mean loss for those physicians who reported losing time was 78 minutes per day.
“The loss of free time that our respondents reported was large and pervasive and could decrease access or increases costs of care,” wrote McDonald and his colleagues. “Policy makers should consider these time costs in future EMR mandates."
Some media reports used the term “waste time” to describe the results of the survey. “We didn’t say that, but I believe it,” McDonald said in an interview with CMIO.net. “Why should doctors be losing 48 minutes of time a day that they could be using to care for their patients?"
The survey also gave respondents the opportunity to provide comments, which weren't included in the JAMA Internal Medicine article. What these comments suggested, McDonald said, is that the use of electronic medical records was causing many physicians "considerable pain."
For example, McDonald said, comments from two doctors indicated that they were both ready to quit practicing because of the frustration of dealing with electronic medical records.
Those kinds of comments confirm what studies have shown—that electronic medical records are making some doctors miserable.
For example, a RAND study released last year found that life with EMRs was so unsatisfactory that 20 percent of physicians wanted to return to paper records.
McDonald believes that isn’t necessarily a bad idea when it comes to note taking, which he believes is a big cause of physician dissatisfaction when it comes to electronic medical records. One obvious solution, he said, could be the use scribes.
There have been several studies supporting the idea that the use of scribes not only increases efficiency, but also increases physician satisfaction. For example, one study in the Journal of Urology found that the use of scribes in a academic urology department increased physician satisfaction rates from 19 percent to 69 percent.
In addition to the use of scribes, McDonald and his colleagues also wrote that ambulatory practices could benefit from other approaches used by high-performing practices, such as the use of standing orders and talking instead of e-mail to recapture time lost on the EMR.
The researchers also found that trainees reported losing just 18 minutes of free time associated with EMR use and said that it was a matter of speculation whether that was due to better computer skills, half-day clinic assignments (with less exposure to EMR use), or other factors.
McDonald is known as one of the pioneers in the field of electronic medical record systems, having adopted one of the nation’s first EMRs—the Regenstreif Medical Record System.