Tuesday, October 31, 2023

Rise in Virtual Visits Linked to More After-Hours EHR Work

As virtual visits for health care expanded rapidly in response to the COVID-19 pandemic, the amount of time physicians spent using electronic health records (EHRs) outside of clinic hours also crept up. The findings, which were published yesterday in JAMA Internal Medicine, suggest that physicians offering telemedicine visits may need more time to complete EHR documentation.

“[A]lthough telemedicine may offer a convenient option for patients, it exhibits a dramatic dose-response association with EHR time that exacerbates EHR burden for physicians,” A. Jay Holmgren, Ph.D., M.H.I., of the University of California, San Francisco, and colleagues wrote. Previous studies have shown that physicians who spend more time working on EHRs outside of work are more likely to report burnout, the authors noted.

Holmgren and colleagues analyzed EHR data from physicians providing outpatient care at UCSF Health one year before the COVID-19 pandemic (August 2018-September 2019) and after the onset of the pandemic (August 2020-September 2021). The study sample included 1,052 physicians observed over 115 weeks.

From before the COVID-19 pandemic to after its onset, telemedicine use increased from 3.1% to 49.3%, the authors reported. The amount of time that physicians spent working in EHRs during scheduled hours increased from 4.53 hours to 5.46 hours (per eight hours of patient care) during this time. Other key findings from the report include the following:

  • Time spent working in EHRs outside of scheduled hours increased from 4.29 hours to 5.34 hours.
  • Time spent on clinical documentation (for example, writing clinical notes) during and outside of scheduled hours increased from 6.35 hours to 8.18 hours.
  • The average number of weekly patient portal messages received by physicians increased from 16.76 to 30.33, and messages sent to patients increased from 13.82 to 29.83.

“Critically, the amount time spent on EHR work among the physicians in this study underscores the importance of reducing burden: for every 8 [patient scheduled hours], physicians were spending 5 or more hours outside [patient scheduled hours] working in the EHR,” Holmgren and colleagues wrote. “Health systems should consider the burden of EHR time for physicians who deliver care via telemedicine when considering scheduling, number of patients under care (i.e., panel size), and productivity expectations.”

For related information, see the Psychiatric News article “The Hybrid Model: New Normal or Unstable Transition Phase?.”

(Image: iStock/Delmaine Donson)

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