Recent headlines confirm that the burden of EMR use is staggering. A 2016 study of ambulatory practice in the Annals of Internal Medicine concluded that for every hour spent in direct clinical time with patients, physicians devote an additional 2 hours on EMR and desk work. A 2013 analysis of EMR use in a community hospital emergency department showed that an average of 28% of physician time was spent in direct patient care and 44% on EMR data entry. This amounted to about 4,000 mouse clicks for each 10-hour ED shift.
The authors concluded that “emergency department physicians spend significantly more time entering data into electronic medical records than on any other activity, including patient care.”
In my own experience, it took about 3 minutes to dictate an entire complex ED patient encounter using speech-recognition software while viewing a laminated dictation template. The average time required to document each patient encounter skyrocketed to 14 minutes when we adopted (or should I say “became victims of”) our first EMR system. While not everyone’s experience will be the same, I believe I can sense the collective nodding of thousands of practitioners’ heads in agreement. One of the most respected and experienced ED physicians I know resigned as a direct result of “EFS” (EMR Frustration Syndrome.) The rest of us stayed and universally developed “EBS” (EMR Burnout Syndrome). A Medscape report found that computerization of practice ranked as the third leading cause of burnout among physicians.
A risk manager’s desire to promote a complete, appropriate, detailed medical record is understandable. In my past roles as a risk officer, claims manager, and medical-legal consultant, I can tell you with certainty that the medical record can make or break a malpractice case – and even prevent a claim from being filed in the first place. During orientation of new practitioners, I would teach them to document well and tell them, “Use the history, risk factors, exam and test results to shape your differential diagnosis and medical reasoning into a compelling story so logical that any reasonable practitioner and every juror can only come to one conclusion – yours.”
Keeping risk management happy is not a bad idea, but last time I checked, it was the physician, PA, NP or nurse who was seeing patients and using the EMR - not the risk manager. Let’s get back to the inefficiency factor and the problem of more time spent in the EMR than with patients. Other than reverting to pre-EMR days, what can be done to satisfy the end-user practitioner? Various solutions have been proposed and tried with varying degrees of success. Here are a few ideas and observations:
If you're interested in learning more about an EHR plug-in that was designed by physicians for physicians to improve documentation efficiency and patient safety, click here to read about Medical Professor.