Stress in the System

Researchers examine burden of electronic health record on primary care clinicians

Photo of physician holding a pen and a notebook and typing on a computer keyboard
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Primary care clinicians face a heavy administrative burden, spending significantly more time using electronic health records (EHR) than their counterparts in other specialties.

With studies demonstrating high rates of burnout among primary care clinicians, researchers from Brigham and Women’s Hospital and collaborators set out to examine how different types of primary care clinicians interface with the EHR.

They found that general internal medicine and family medicine clinicians spent an average of two hours actively using the EHR each day, while general pediatric clinicians actively used the system for about an hour and a half.

These findings, across all primary care specialties, included about 30 minutes of EHR usage after working hours. Results are published as a research letter in JAMA Network Open.

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“How primary care clinicians spend time with the record affects care in several ways,” said Lisa Rotenstein, HMS instructor in medicine at Brigham and Women’s and corresponding author on the paper.

“If physicians can be more efficient, there will likely be less burnout; and if less time is spent on the EHR, there is more time to interact with patients and to ensure that the truly important things get done,” she said. 

In their study, the researchers analyzed data from 349 ambulatory health care organizations in the U.S. using the same EHR vendor, Epic Systems, in 2019.

The authors broke down their analysis of time spent using the EHR according to activity: clinical review, notes, exchanging messages, and placing orders. They explain that because their analysis captures only time actively spent working in the EHR, it is likely an underestimate of clinicians’ total engagement with the EHR, and the time spent is likely even higher.

The researchers’ analysis revealed that pediatricians spent half as long on messages from patients or their families and two-thirds as much time reviewing charts and orders compared to their primary care counterparts; however, they spent the same amount of time on notes.

While some differences in EHR usage could be driven by patient complexity, consistent findings on note-taking burdens across primary care specialties indicate that the documentation functions in the EHR could be improved.

Virtual or AI-powered scribes could reduce the burden of notetaking across primary care specialties and can be evaluated in future studies, the authors state. Interventions that streamline messaging and placing orders are also research priorities.

“The physician and patient experience are inextricably linked, as we know that burnout has consequences for quality of care and patient outcomes in addition to its important consequences for individual physicians,” said co-author David Bates, HMS professor of medicine and chief of the Division of General Internal Medicine and Primary Care at Brigham and Women’s.

“Future studies should help us better understand why pediatric clinicians are spending less time on the EHR than other primary care clinicians, and whether there are any lessons about how pediatric EHRs are designed that could be applied to other specialties,” Bates said. 

There was no external funding for this work.

Adapted from a Brigham and Women’s news release.