Doctors and Computers

As information technology spreads in health care, questions arise about the extent to which it improves outcomes and about the impact it has on physician productivity, workflow, and job satisfaction.  Research in Health Affairs examines how physicians spend their time, with emphasis on interactions with information technology.   (HA Article)   The researchers used electronic medical record access logs to track physician use of computer systems, based on 471 primary care doctors who treated over 765,000 during the period 2011 to 2014.  About half the physicians were part-time, 69% were women and the average age was 48.  In estimating time with a patient, the researchers did some validation tests using in-person observations and tape recordings.  The estimates based on EHR use were about two minutes shorter than those from in-person observations and 3 minutes shorter than those with tape recordings.  Physicians most commonly seemed to access the EHR system shortly after a face-to-face encounter began.

The average total daily logged time using the system per physician was 3.17 hours of pure desktop time and 3.08 hours during face-to-face visits.  The average number of visits per doctor per day was 12.3, with part-timers obviously pulling this average down, and the average number of minutes per in-person encounter was 15 minutes.  Of the 3.17 average hours per day of desktop time, 2.82 hours were at the clinic site and .35 were remote access (i.e., the doctor was working at home).  1.42 of the 2.82 hours related to patients being seen in-person that day and 1.40 on other patients.  Progress note typing was the primary activity during desktop time.  Other uses  were logging telephone encounters, exchanging messages with patients, and refilling prescriptions.  From a  big picture perspective, this study suggests that physicians spend as much time on a computer as they do with a patient, and even when they are with a patient they are often using the computer.  Doctors generally don’t report being happy with this, and many have begun doing things like using scribes for documentation so that they have more pure face-to-face time with patients.  There also are reimbursement implications; current methods may not adequately reflect the time spent using information systems to support patient care, much less pay for virtual encounters like email or phone calls.