Blog | Thursday, September 11, 2014

QD: News Every Day--Internists losing 48 minutes a day to EMR use


Internists lose an average of 48 minutes a day to electronic medical record (EMR) use, including data entry and note writing, a survey found.

ACP members and staff sampled 1% of its membership, including attending physicians, residents, and fellows, from its research panel. Researchers then used random sampling to ensure balance and added nonmember internists. The 19-question survey was sent to 900 ACP members and 102 nonmember internists who provided ambulatory care; 411 responded. While 3 of 4 were attending physicians, trainees were more likely to respond. Respondents were experienced EMR users, as 70.6% used all of the EMR functions, and 82.5% had EMRs for more than 1 year. Researchers honed in on free time to learn more about the EMR’s overall effect on internist’s time, including nonclinic time.

Results appeared online Sept. 8 in a researcher letter in JAMA Internal Medicine.

The physicians reported using 61 EMR systems and came from a broad range of practice types. Researchers reported that 9 EMRs were used by 20 or more respondents, accounted for 324 (78.8%) of all users, and among these systems, users lost free time (P<0.05 for all). Of these 9, the Veterans Affairs’ EMR system was associated with the least loss of free time (−20 minutes) (P=0.04).

Researchers wrote, “Among all respondents, 89.8% reported that at least 1 data management function was slower post-EMR adoption, and 63.9% reported that note writing took longer. Surprisingly, a third (33.9%) reported that it took longer to find and review medical record data with the EMR than without, and a similar proportion, 32.2%, that it was slower to read other clinicians’ notes.”

Among all respondents, attending physicians lost a mean of 48 minutes per clinic day (P<0.001), compared to trainees, who lost a mean of 18 minutes per day (P<0.001). Among the 59.4% of all respondents who lost time, the mean loss was 78 minutes per clinic day.

“The loss of free time that our respondents reported was large and pervasive and could decrease access or increase costs of care,” the researchers wrote. “Policy makers should consider these time costs in future EMR mandates. Ambulatory practices may benefit from approaches used by high-performing practices—the use of scribes, standing orders, talking instead of e-mail—to recapture time lost on EMR. We can only speculate as to whether better computer skills, shorter (half-day) clinic assignments with proportionately less exposure to EMR time costs, or other factors account for the trainees’ smaller per-day time loss.”