Primary care physicians spend the most time on the EHR compared with other physician specialties. Increased time spent on the EHR—especially when done after hours—may lead to emotional exhaustion and higher rates of physician burnout, according to new research published in JAMA Network Open.
The cross-sectional study, “System-Level Factors and Time Spent on Electronic Health Records by Primary Care Physicians,” included 307 primary care physicians across 31 primary care practices at Massachusetts General Hospital and Brigham and Women’s Hospital in 2021. Total EHR time, pajama time and total time on the EHR inbox per visit were measured by activity log data from the EHR database Pajama time was defined as time spent on the EHR between 5:30 p.m. and 7 a.m. weeknights and any time on the weekends.
There was a lot of variation in EHR time per visit across primary care physicians. In total, physicians typically spent 36.2 minutes on the EHR per visit with a first quartile of 28.9 minutes and a third quartile of 45.7 minutes. This included 6.2 minutes of pajama time per visit and 7.8 minutes on the EHR inbox per visit. Primary care visits are scheduled for 30 minutes across the health system.
Variation was also seen across the clinics in the sample. For example, median total EHR time ranged from 23.5 to 47.9 minutes per visit across clinics. The median pajama time per visit ranged from 1.7 to 13.1 minutes across clinics
“EHR time burden, and the burnout associated with this burden, represent a serious threat to the” primary care physician workforce, says the study.
Burdensome EHR systems are a leading contributing factor in the physician burnout, and reducing physician burnout is a critical component of the AMA Recovery Plan for America’s Physicians.
Far too many American physicians experience burnout. That's why the AMA develops resources that prioritize well-being and highlight workflow changes so physicians can focus on what matters—patient care.
Here is how to modify primary care clinic workflows and staffing to enhance physician interactions with the EHR.
“More team contribution to orders was associated with less EHR time per visit, even when considering the specific staffing ratios—nurses to clinicians, medical assistants to clinicians, secretarial staff to clinicians,” said AMA member and lead author Lisa Rotenstein, MD. She is an internist and medical director of ambulatory quality and safety at University of California, San Francisco Health.
Dr. Rotenstein is a recipient of research grants provided by the AMA EHR Use Research Grant program, which has provided more than $2 million in funding to researchers nationwide since 2020.
“This highlights an opportunity for physicians, clinics and health systems to proactively and systematically engage team members in EHR-related work,” said Dr. Rotenstein.
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“We also found that having a pharmacy technician in the clinic where you practice was associated with less EHR time,” Dr. Rotenstein said.
This suggests “that investment in this resource—which helps with medication-refill issues and prior authorizations—could be particularly valuable” in reducing EHR time in multiple categories.
There is still substantial variation in time spent on the EHR at the primary care physician level and clinic level. This variation is unexplained.
That is why “there is likely still some role for individually targeted interventions to reduce” primary care physician level variation in EHR time alongside system-level interventions, the study says.
“Practicing in a community health center was also associated with less EHR time,” Dr. Rotenstein said. “However, to the extent that this association reflects digital access disparities among patients served in a community health center, that may not be a good thing.”
Meanwhile, “in previous studies and in unadjusted analyses for this study, being a female physician was associated with less EHR time,” she said. But that was not the case when adjusting for primary care physician, clinic, team and patient panel factors.
“This suggests that previously demonstrated differences in EHR time by female physicians may be influenced by panel, clinic or team collaboration factors rather than being solely the result of a physician’s sex.”