A couple of interesting studies to report on. This first comes from the Rand Institute’s work on hospital prices and transparency. The overall finding of the research is that commercial health plans, like those purchased by employers or individuals, typically pay over 200% more for the same service compared to Medicare reimbursement. There is wide variation, typically dependent on a health plan’s size in a particular area and ability to negotiate better prices. The pricing gap has no justification other than large health systems believing they can get away with it. Meanwhile, these systems, which are largely non-profits, pay their executives millions of dollars a year and have bloated administrative staff. This could have been avoided by stopping mergers between formerly independent hospitals and by banning hospitals from purchasing physician practices. Now, sooner or later some regulatory fix will be necessary. At this link you can find the data and various reports and press releases. (Rand Report)
The other research is part of an ongoing series about the administrative burden on physicians. A caveat is that this study is part of a series done by researchers who are ideologues–they don’t care what the facts are, they believe in a single-payer system so they publish research which is slanted and misleading to try to justify moving to a total government-run system. That, in my judgment would be a complete disaster. But the issue they are addressing, the amount of time and expense involved in clinicians dealing with reimbursement and regulatory paperwork, is real. This is a survey, so who responds and how the questions are asked matters. 65% of doctors expressed satisfaction with their electronic medical records system, but 58% said it required documentation time that took away from patients. The average physician said they spent about 1.8 hours a day doing documentation outside of office hours. I don’t believe that, but I do believe the overall paperwork burden on doctors is high. And it is a major factor in job dissatisfaction and burnout. Much of the paperwork is caused by the government that these authors love–there are literally hundreds of regulatory documentation requirements. (JAMA Study)
The Healthy Skeptic is a website about the health care system, and is written by Kevin Roche, who has many years of experience working in the health industry. Mr. Roche is available to assist health care companies through consulting arrangements through Roche Consulting, LLC and may be reached at 
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A friend who is a cardiologist at a teaching hospital told me he averages 4 hours a day on paperwork etc. of course some of that is the nature of work at a teaching hospital but he says it is double what it was 20 years ago.
I’ll never forget the first and only time I saw a particular female doctor at Allina. She spent 90% of the appointment telling me how horrible it was being a doctor after all the money her education cost her and how she couldn’t wait to quit. One of the weirdest medical appointments of my life.
“The average physician said they spent about 1.8 hours a day doing documentation outside of office hours. I don’t believe that…”
Believe it, Kevin! Rationale: First, I agree with your warning that, as a survey, this “study” has all the weaknesses inherent in such “research.” Second, on the one hand, there is no doubt that EMRs overall has engendered a significant increase in physicians’ productivity and income. I can now generate a consult or H&P – and a more meaningful one – in one-third the time I did a decade ago by hand or by dictation. Ditto for office notes.
On the other hand, it is impossible to quantify how many useless or duplicate entries Epic requires me to make. “Why are you changing this dose, doctor?” “Why are you discontinuing this medication?” “You entered the diagnosis for this test a minute ago. Please enter it again!” “Our records indicate that Epic has warned you 10,000 times this year that combining an anticoagulant and aspirin can increase bleeding, but here is warning 10,001!” And so on. These clicks and typing add up – I’m sure to 5 or 6 hours per week if not more (I don’t count, but Epic does!) Does anyone DO anything with this data? Of course not. It comes “built-in” to the EMR, and my responses are sent into cyberspace.
Third, every week my colleagues and I spend an entire half-day or more – usually on weekends, meaning time away from loved ones and hobbies – “catching up” on documentation, most of it with no perceivable benefit to patient well-being. Thus, I think 1.8 hours a day x 5d = 9 hours/week is an underestimate.
On balance, EMRs have been beneficial. But the drones in IT who have never and (thankfully) will never practice medicine have not passed “down” to us the many benefits that technology COULD have engendered to allow us to spend more time with the patient, rather than less.