BACKGROUND AND PURPOSE:

• Gaffney et al. (JAMA Internal Medicine, 2022) assessed the burden of medical documentation on US office-based physicians

METHODS:

• Cross-sectional study
  • 2019 National Electronic Health Records Survey
• Participants
  • US office-based physicians
• Exposures
  • Physician specialty
  • Electronic health record use
  • Staff support for documentation (e.g., scribes)
  • Participation in an Accountable Care Organization or pay-for-performance program (value-based purchasing [VBP] participation)
• Study design
  • Survey question: “On average, how many hours per day do you spend outside of normal office hours documenting clinical care in your medical record system?” (none, <1, 1-2, >2-4, or >4 hours).
  • Mean daily hours devoted to documentation outside office hours estimated by recoding categorical responses at the midpoint (for the highest category, the minimum) of response
  • 5 measures of satisfaction with the electronic health record (EHR) and time spent documenting.
• Primary outcomes
  • Mean daily hours devoted to documentation outside office hours
    • None, <1, 1-2, >2-4, or >4 hours
  • Measures of satisfaction with the EHR and time spent documenting

RESULTS:

• 1524 respondents
  • ≥50 years: 78.6%
• Survey results across primary care, surgical, and medical specialties
  • Reported satisfaction with EHR: 64.1%
  • Found documentation to be easy: 64.5%
  • Disagreed that time spend time spent documenting was appropriate and did not reduce time spent with patients: 58.1%
  • Agreed that documentation solely for billing purposes increased total documentation time: 84.7%
• There were no significant differences by physician specialty
• Time spent completing documentation outside of office hours
  • Overall: mean 1.77 (95% CI, 1.67 to 1.87) hours daily
• There were no significant differences in time spent on documentation with staff support (e.g., scribes)
• Physicians who used EHRs spent significantly more time on documentation than those who did not use EHRs (P<0.001)
  • With EHRs: 1.84 (95% CI, 1.74 to 1.94) hours daily
  • Without EHRs: 1.10 (95% CI, 0.83 to 1.37) hours daily
• Physicians participating in VBP also spent more time on documentation than those were not participating in VBP (P<0.001)
  • VBP: 2.02 (95% CI, 1.86 to 2.19) hours daily
  • No VBP: 1.58 (95% CI, 1.47 to 1.69) hours daily
• Estimate of hours spent documenting in 2019
  • 125 million hours documenting outside office hours
  • Assumes a 5-day work week and 47-week work year

CONCLUSION:

• US physicians are burdened by documentation outside of office hours
• This burden is not lessened by staff support (e.g., scribes) for documentation
• The authors state

Per our analysis, VBP participation is associated with a higher documentation burden, a finding consonant with the doubling in length of EHR ambulatory notes in the VBP era (among EHR users)

Reconsideration of the US approach to medical documentation may be warranted

Learn More – Primary Sources:

Medical Documentation Burden Among US Office-Based Physicians in 2019: A National Study

AAFP: Value-Based Payment

Related ObG Topics:

To What Extent do Electronic Health Records Systems Contribute to Physician Burnout?

Where Does all the Money Go? Estimated Administrative Costs Related to Physician Billing Activities

Does the Electronic Health Record Match with the Actual Clinical Exam?

Do Resident Unions Improve Working Conditions and Burnout?