Physicians spend essentially the same time seeing patients as they do on “desktop medicine,” according to new research published in the April issue of Health Affairs.
Researchers from Palo Alto Medical Foundation Research Institute, Sutter Health and Canopy Health, all based in California, used data on physicians’ time allocation patterns captured by over 31 million electronic health record (EHR) transactions from 2011 to 2014, recorded by 471 primary care physicians, who collectively worked on 765,129 patients’ EHRs.
The results of the research were that physicians logged an average of 3.08 hours on office visits and 3.17 hours on “desktop medicine” each day. Desktop medicine, according to the study’s authors, consists of activities such as communicating with patients through a secure patient portal, responding to patients’ online requests for prescription refills or medical advice, ordering tests, sending staff messages, and reviewing test results. Over time, log records from physicians showed a decline in the time allocated to face-to-face visits, accompanied by an increase in time allocated to desktop medicine.
According to the researchers, “The logs suggest that physicians allocate equal amounts of their clinically active time to desktop medicine work and to face-to-face ambulatory care visits. While working on progress notes could be considered pre- or post-service efforts, desktop medicine activities not linked to a face-to-face visit are not reimbursable under typical fee-for-service contractual and regulatory arrangements. Many of those activities—such as care coordination and responding to patients’ e-mail—are of high value to the delivery system and to patients, so the staffing, scheduling, and design of primary care practices should reflect this value.”
In this study, the primary desktop medicine activity both in the clinic and remotely was typing progress notes. Physicians generally spent more time on progress notes in the clinic on visit days. Other desktop medicine activities, in descending order of time allotted, were logging telephone encounters, exchanging secure messages with patients, and refilling prescriptions. Common desktop medicine activities for patients not seen that day were orders for services, chart reviews, letters for external use, and scanned documents.
In recent months, physician burnout from EHR use has been a trendy topic of conversation in healthcare circles. Newly confirmed federal health officials, Tom Price, M.D., U.S. Department of Health and Human Services (HHS) Secretary, and Seema Verma, Centers for Medicare and Medicaid Services (CMS) Administrator, have both mentioned that they would like to make health IT less burdensome on doctors. Indeed, a study published last September in the Annals of Internal Medicine found that during office hours, physicians spend nearly 50 percent of their time on EHR tasks and desk work, and outside office hours, they spend another one to two hours of personal time each night doing additional computer and other clerical work.
The researchers for the Health Affairs study further noted that within new healthcare policy programs for Medicare clinicians, such as the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) and CMS’ Comprehensive Primary Care Plus model, practices will have the flexibility to deliver care in the manner that best meets patients’ needs, without being tied to the office visit. “This is an explicit move away from payment for visits only, and an acknowledgment that critical aspects of patient care that happen outside the visit require appropriate compensation,” the authors wrote.
