The amount of time that providers spend using electronic health records (EHRs) to support the care delivery process is a concern for the U.S. health care system. Given the potential effect on patient care and the high costs related to this time, particularly for medical specialists whose work is largely cognitive, these findings warrant more precise documentation of the time physicians invest in these clinically focused EHR functions.
To describe how much time ambulatory medical subspecialists and primary care physicians across several U.S. care delivery systems spend on various EHR functions.
U.S.-based, adult, nonsurgical, ambulatory practices using the Cerner Millennium EHR.
155 000 U.S. physicians.
Data were extracted from software log files in the Lights On Network (Cerner) during 2018 that totaled the time spent on each of the 13 clinically focused EHR functions. Averages per encounter by specialty were computed.
This study included data from approximately 100 million patient encounters with about 155 000 physicians from 417 health systems. Physicians spent an average of 16 minutes and 14 seconds per encounter using EHRs, with chart review (33%), documentation (24%), and ordering (17%) functions accounting for most of the time. The distribution of time spent by providers using EHRs varies greatly within specialty. The proportion of time spent on various clinically focused functions was similar across specialties.
Variation by health system could not be examined, and all providers used the same software.
The time spent using EHRs to support care delivery constitutes a large portion of the physicians' day, and wide variation suggests opportunities to optimize systems and processes.
Primary Funding Source:
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Author, Article, and Disclosure Information
Cerner Corporation, Kansas City, Missouri (J.M.O., D.M.)
Disclosures: Dr. Overhage reports personal fees from Cerner Corporation outside the submitted work. Dr. McCallie reports personal fees from Cerner Corporation during the conduct of the study. Disclosures can also be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M18-3684.
Editors' Disclosures: Christine Laine, MD, MPH, Editor in Chief, reports that her spouse has stock options/holdings with Targeted Diagnostics and Therapeutics. Darren B. Taichman, MD, PhD, Executive Editor, reports that he has no financial relationships or interests to disclose. Cynthia D. Mulrow, MD, MSc, Senior Deputy Editor, reports that she has no relationships or interests to disclose. Jaya K. Rao, MD, MHS, Deputy Editor, reports that she has stock holdings/options in Eli Lilly and Pfizer. Christina C. Wee, MD, MPH, Deputy Editor, reports employment with Beth Israel Deaconess Medical Center. Sankey V. Williams, MD, Deputy Editor, reports that he has no financial relationships or interests to disclose. Yu-Xiao Yang, MD, MSCE, Deputy Editor, reports that he has no financial relationships or interest to disclose.
Reproducible Research Statement:Study protocol and statistical code: Available from Dr. Overhage (e-mail, marc.
Corresponding Author: J. Marc Overhage, MD, PhD, Cerner Corporation, 2800 Rock Creek Parkway, Kansas City, MO 64117; e-mail, marc.
Correction: This article was corrected on 25 August 2020 to clarify the active EHR times reported in Table 2.
Current Author Addresses: Dr. Overhage: Cerner Corporation, 2800 Rock Creek Parkway, Kansas City, MO 64117.
Dr. McCallie: 6301 West 181st Street, Stilwell, KS 66085.
Author Contributions: Conception and design: J.M. Overhage, D. McCallie Jr.
Analysis and interpretation of the data: J.M. Overhage, D. McCallie Jr.
Drafting of the article: J.M. Overhage, D. McCallie Jr.
Critical revision of the article for important intellectual content: J.M. Overhage, D. McCallie Jr.
Final approval of the article: J.M. Overhage, D. McCallie Jr.
Administrative, technical, or logistic support: D. McCallie Jr.
Collection and assembly of data: J.M. Overhage.
This article was published at Annals.org on 14 January 2020.