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EHR documentation too focused on billing, doctors say


One-third spend at least two hours daily on documentation outside of office

American doctors are of two minds when it comes to their EHRs. They are satisfied with the technology overall but resent the amount of documentation time EHRs require for billing purposes.

Those are among the results of an analysis of responses to the 2019 National Electronic Health Records survey from1,524 office-based physicians in primary care, surgical and medical specialties. The findings, representing more than 300,000 physicians nationwide, were published in JAMA Internal Medicine.

Overall, 64% of respondents said they were satisfied with their EHR, while 28% were dissatisfied and 8% were neutral. Similarly, 64.5% said EHR documentation is easy, versus 35.5% who found it difficult. The highest level of overall satisfaction—67%—was among primary care doctors, while surgeons gave the highest marks for ease of documentation at 67.4%.

On the other hand, 58% of respondents felt that EHR documentation takes too long and that it reduces the amount of time they can spend with patients. And by a margin of 85% to 15%, respondents agreed that documentation done solely for billing increases their total documentation time.

Survey respondents spent an average of 1.77 hours per day outside of office hours completing EHR documentation. But nearly 33% of respondents said they spent at least two non-office hours per day, including 35% of primary care specialists, 32% of medical specialists, and 28.6% of those in surgical specialties. The study’s authors estimate that physicians spent a total of 125 million hours documenting outside of office hours during the year.

The study also showed that participants in a pay-for-performance program or accountable care organization (ACO) spent an average of 2 hours per day on documentation, compared with 1.58 hours among those who were not part of such a program. The authors call this finding consistent with other studies that show EHR ambulatory notes have doubled in length since the introduction of value-based programs and ACOs.

The study, “Medical Documentation Burden Among US Office-Based Physicians in 2019: A National Study” was published online March 28 in JAMA Internal Medicine.

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Jennifer N. Lee, MD, FAAFP
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