Letters from Maine

The electronic elephant

Publish date: October 12, 2017

Five years ago, while I still was actively practicing primary care pediatrics, I did a rough calculation that the EHR the practice had purchased was adding an hour to my workday. We were not computer neophytes. This was our third EHR system in 10 years. Not a single minute of that extra time included face-to-face interaction with my patients. In the ensuing years, I have been listening to former colleagues and reading emails from readers of this column. It is clear that my unfortunate experience with our new EHR in 2012 was just a hint at how bad things would get for primary care physicians indentured to EHRs. The short learning curve that was promised has not flattened out, and my rough calculation of an hour at the computer was clearly an underestimate. Most physicians I hear from feel they are spending significantly more than an hour scrolling and clicking.

Although I frequently have used this column to grumble about EHRs, I have been hesitant to launch into a vein-popping tirade because my evidence has been primarily anecdotal. However, a few weeks ago a friend shared a link to a study that provided some startling figures that went beyond my expectation (“Tethered to the EHR: Primary care physician workload assessment using EHR event log data and time motion observations,” Ann Fam Med. 2017;15[5]:419-26).

^{CreativaImages/Thinkstock}

In following 142 family medicine physicians over a 3-year period, the investigators found that clinicians spend 5.9 hours of an 11.4-hour workday in the EHR. Of this time, 4.5 hours were spent during clinic hours and 1.4 hours after hours. In the investigators’ words: “Primary care physicians in our study worked an average of 11.4 hours per weekday, both during and after clinic hours, with nearly 6 hours spent interacting with the computer.”

Let that sentence sink in for a moment. How do those numbers compare with your own practice experience? Has anyone in your clinic or hospital taken the time to collect the data? I suspect that your time expenditure on the EHR is similar. Are you or anyone else in your group doing anything more than grumbling to one another about this situation?

Isn’t it time for us to do more than just grouse about this electronic elephant in the room? How many successful businesses would tolerate a situation in which the employees responsible for producing the company’s signature product are allowed to spend half of their time idle? From a purely business perspective, the current EHR/provider interface makes no sense.

Although the cost of physician productivity misdirected to EHRs is probably less than the billions of dollars lost to overpriced medication in this country, this is a topic that deserves a spotlight in ongoing discussions of the Affordable Care Act. At a time when the adequacy of our physician workforce is being questioned, we must take seriously the anecdotal evidence that frustration with EHRs is driving older and experienced physicians into early retirement.

Dr. William G. Wilkoff

And there is the hot topic of physician burnout and quality of life issues. If I were a physician spending half my time on the computer, of which more than an hour and a half was after clinic hours, I think I would start doing something about that before I enrolled in a mindfulness program. I am sure that the American Academy of Pediatrics has more than one committee working on the problem, but the physician time lost to EHRs deserves a higher priority. In the long run, computers have great potential for improving the delivery of health care. However, we are all suffering through a failed beta test that has gone on far too long.

Our patients can be our best allies because most of them don’t like us looking at our computer screens when we should be looking them in the eye … and listening. Like it or not, we now have a president who is a disruptor of the status quo. Maybe it’s time for us to follow his example and begin making some real noise about the personal and financial cost of EHRs. Talk to your legislators, practice administrators, the American Academy of Pediatrics, anyone … even if they don’t seem to be listening.

Dr. Wilkoff practiced primary care pediatrics in Brunswick, Maine, for nearly 40 years. He has authored several books on behavioral pediatrics, including “How to Say No to Your Toddler.”

Email him at pdnews@frontlinemedcom.com.

The electronic elephant

Recommended Reading