EHR documentation burdens increasing with virtual care expansion, says study

A new study published in the Journal of the American Medical Association Network compared messaging among outpatient physicians before and after the onset of the COVID-19 pandemic, finding that it mainly involved documenting visits and not about sending messages to patients.


The study suggested that if the expansion of telemedicine indicates that physicians are spending more time in EHRs overall, healthcare systems and policymakers may need to adjust productivity expectations and reimbursement policies.

The researchers from the Division of Clinical Informatics and Digital Transformation in the Department of Medicine at the University of California, San Francisco, and the American Medical Association studied the documentation activity of 1,052 outpatient physicians at UCSF Health over 115 weeks spanning the beginning of the COVID-19 pandemic. 19 crisis. -19 pandemic.

Their multivariable regression model analyzed weekly EHR metadata, comparing the same measurements during a year before the pandemic – August 2018 – September 2019 – with the same period one year after its start – August 2020 – September 2021.

They found that the time physicians spent in the EHR during the patient’s scheduled hours increased from 4.53 to 5.46 hours per eight scheduled patient hours.

Outside of PSHs, the time they spent documenting in the EHR increased from 4.29 to 5.34 hours.

The total time spent by outpatient physicians documenting in EHRs – during and outside of PSHs – increased from 6.35 hours before the pandemic to 8.18 hours in September 2021, according to the study.

Weeks with a mix of face-to-face and telemedicine visits or all telemedicine had more EHR time during PSHs than all face-to-face weeks, with similar results for EHR time outside of PSHs, the researchers said.

“Health systems may need to adjust productivity expectations for physicians and develop strategies to address the EHR documentation burden for physicians,” they concluded.


In the throes of the pandemic, the study’s lead author, A. Jay Holmgren of UCSF, previously collaborated with other researchers from Stanford, Harvard and other universities who suspected that the rise of telehealth could be responsible for the increase in the amount of time that doctors spent in the EHR.

Their 2021 Journal of the American Medical Informatics Association A study that looked at the EHR metadata of ambulatory care physicians across 366 US healthcare systems using Epic from December 2019 to December 2020 found that basket messages and clinical assessment were two key factors driving the number of daily EHR minutes increased.

“Policymakers and healthcare system leaders should keep these new demands on physician time in mind as they develop future reimbursement models and workflows, while ensuring that EHR-induced physician burnout is not exacerbated,” he said. researchers. JAMIA.

More recently, Epic has looked to telehealth data to determine the effectiveness of virtual care and advocate for further reimbursement.

During the 35 million telehealth visits between March 1, 2020 and May 31, 2022, most patients did not require in-person visits within 90 days of online appointments, the EHR vendor researchers said.

They said the results of this analysis of Epic’s data indicated that virtual visits are an effective “alternative, rather than dual” care modality and that because telehealth increases access to care, “payers should expand coverage of telehealth visits.” outside the pandemic exemption.

Although the telehealth waiver was extended by two years in the 2022 Omnibus, the Telehealth Expansion Act of 2023 gives citizens with high-deductible health insurance and savings accounts permanent access to telehealth and other remote health care services without meeting their minimum out-of-pocket costs. risk. First.

“The expansion allows people to start the cycle of first-line treatment and follow other treatment options recommended to them by their doctor or primary care provider without worrying about high costs, deductibles or transportation issues,” said Kamala Green, social drivers of health program manager at Government services, told Healthcare IT news in August.


“Understanding the drivers of EHR burden, including EHR time and patient messages, can directly inform strategies to address physician burnout,” researchers said. “Given the COVID-19-induced expansion of telemedicine – now used for a substantial portion of outpatient encounters – its association with EHR burden should be evaluated.”

Andrea Fox is editor-in-chief of Healthcare IT News.

Healthcare IT News is a HIMSS Media publication.