You’re not imagining it: doctors are spending more time than ever in their EHRs

Does it feel like you’re spending more time than ever in your EHR? It’s because you probably are—especially if you’re a primary care doctor.

A team of researchers studied electronic health record (EHR) time and inbox message volume among 141 primary care physicians (PCPs) at UW Health, the integrated health system at the University of Wisconsin-Madison. The study took place over two periods, from May 2019 through February 2020 and again from April 2022 through March 2023.

The researchers examined several aspects of EHR use, including total time, time in orders, time in notes, time in inbox, and time in clinical review, all per eight hours of clinical appointments. They also looked at time spent in the EHR outside of scheduled hours both on days with appointments and on unscheduled days.

They found that during the 2022-2023 period doctors spent about 30 minutes, or 7.8%, more time in their EHRs per eight hours of clinical appointments compared to the 2019-2020 period. Time spent in orders was up 231 minutes, or 60%, and time spent in the inbox increased by 14 minutes, or 24%. Clinical review time was up by 7.2 minutes, or 13%, and on notes 2.9 minutes, or 2.3%.

In addition, time spent in the EHR outside of scheduled hours on days with scheduled appointments was up by 6.4 minutes, or 8.2%, while on unscheduled days it increased by 13.6 minutes, or 20%.

Requests for medical advice and prescription-related messages sent via UW Health’s MyChart patient portal were up by 55.5% and 19.5%, respectively. However, the study fou8nd that most of those increases occurred through the period ending in early 2022 with the volume of messages stabilizing thereafter.

The authors attribute the increase in EHR time to several causes. UW Health has seen steady growth in the percent of patients with MyChart access, with close to 80% how having an active account. The rapid transition to telehealth and increased portal access at the start of the COVID-19 pandemic may have caused some patients to expect immediate responses to their queries.

In addition, they say, the 21st Century Cures Act’s requirement of immediate release of test results has led to situations where doctors get questions from patients about the results before the doctor gets the results in their inbox. “These policy changes impact primary care patient messaging behaviors and, therefore, overall PCP workload and associated burnout,” the researchers note.

The authors say the continuing growth in physicians’ EHR time and the volume of patient medical advice messages makes it imperative for health systems to “develop strategies to change the overall EHR workload trajectory to minimize PCPs’ occupational stress and mitigate unnecessary reductions in the physician workforce that result from the increased EHR burden.”

The study, “More Tethered to the EHR: EHR Workload Trends Among Academic Primary Care physicians, 2019-2023” appears in the January/February 2024 issue of Annals of Family Medicine.