Electronic health records instead of patient care: waste of time?

By Dr. Liji Thomas, MDJan 14 2020

Healthcare providers are increasingly murmuring about the amount of time and effort as well as money spent on maintaining an electronic health records (EHR) system in the US. The time outpatients spend with doctors and other providers of health care is limited, and when a significant fraction of this is devoted to entering information electronically, it could impact patient care negatively. This is particularly so when the physician is a medical specialist and therefore spends time processing information rather than actually doing things, to assess and manage the patient’s health issue.

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What is EHR?

The EHR is meant to be an electronic cache of information about information collected and stored digitally in a systematic fashion, to be shared with other health care settings easily and efficiently over digital networks. They could include all kinds of data, including the patient’s demographics, medical, personal, and medication history, test and imaging results, as well as billing information and personal data. The advantage of EHR systems is that there is only one file to be modified, which reduces the risk that data will be lost or that old and out-of-date records will be acted on. They help to get a more accurate picture of the patient over time.

The study

A new study was meant to describe the amount of time spent by primary care physicians and outpatient medical specialists in various branches on EHR maintenance. Over 150,000 American physicians were involved, and data was obtained from the Lights On Network (Cerner), from software files logged in during 2018. The data covered the time the physicians spent on filling up each of the 13 EHR functions that concerned clinical data, for about 100 million patient-physician interactions. The average time spent on EHR during one encounter by each specialty was calculated. The study titled, 'Outpatient Physician Time Spent on Electronic Health Records', is published in the Annals of Internal Medicine.

The study found that on average, physicians used about 16 minutes spent with one patient on filling out the EHR. Across the range of specialties, the time spent on various functions was similar. Of this time, a third went on reviewing the records, a fourth went on creating a new document, and about 17% on ordering tests. However, within a single specialty, there was a lot of difference in the way physicians spent their time vis-à-vis EHR. The current findings related to a single software, but different healthcare systems could not be compared.

The problems

One reason why this needs a lot of work is that it carries the potential for costly medical errors. The use of dictation software to maintain EHR is one sure-fire way to introduce a lot of bloopers into the notes. While most of these take a second or two to figure out, many cost the transcription team a lot of time and frustration trying to find out what the physician actually meant to say as opposed to what the software thought was said.

Another pitfall in this system is the use of medical abbreviations. It is estimated that medical errors cost the lives of more patients in the US than strokes or diabetes does, and about 5% of these, amounting to almost 30,000 deaths, were due to the misinterpretation of abbreviations, according to the National Medication Errors Reporting Program for just one year, 2004. In fact, the Joint Commission made out an official list of abbreviations to NOT use in medicine due to their potentially life-endangering effects. To take just one example, does MR mean mitral regurgitation, which is a heart condition, or mental retardation?

The important thing is that the need to fit a patient visit, documentation and ordering all within about 15 minutes has led to the rampant use of abbreviations, especially when doctors have to do this 20 or more times a day in addition to all their other tasks.
And finally, the use of EHR ought to, but doesn’t, make it easier for doctors to follow up on their patients when they are sent to another doctor for a referral or a consultation. There is little or no compatibility between EHRs maintained in different systems, and secondly, clinicians are not able to pick out the details that are of use to them easily because of the unnecessary and unwanted text in which they are buried when they do get a transcript of the patient visit or treatment from the other doctor – due to system regulations and policies. The immense but mostly unused wasted capability of EHR systems makes it a matter of necessity to optimize and refine them to do exactly what they should do – capture medical details accurately and rapidly, share them on demand with other permitted personnel, and save time and energy for physicians to do what they are best at – listen to and examine patients to find out what’s wrong with them, and hopefully fix it.

The take-home

The variation between physicians in the way they used the EHR may indicate the need to bring this system to a more optimal level to improve the level of patient care, because this system uses up a lot of physician time and this should be seen in the form of patient benefits. The use of artificial intelligence, better dictation-to-text software, and efficient EHRs could all help move health care forward, away from a more managed context to a more patient-friendly one. EHR systems may promote population or larger-group research, but at present they promote burnout, increase the load to be processed in an already demanding role, and are hard to use while also requiring much more documentation.