Electronic Health Record Logs Indicate That Physicians Split Time Evenly Between Seeing Patients And Desktop Medicine

TLDR

Physician time is a critical resource, and electronic health record logs provide a powerful, unobtrusive way to study how physicians allocate time between patient visits and desktop activities such as portal communication, prescription refills, test ordering, staff messaging, and result review. The study examined physician work effort using EHR access‑timestamp data. Data from 31 million EHR transactions over 2011–2014 involving 471 primary‑care physicians and 765,129 patient records were analyzed to assess time allocation. Physicians logged roughly equal time on office visits and desktop medicine (≈3 h each), with a trend toward decreasing face‑to‑face visits and increasing desktop work, implying that staffing and payment models should incorporate these desktop activities.

Abstract

Time spent by physicians is a key resource in health care delivery. This study used data captured by the access time stamp functionality of an electronic health record (EHR) to examine physician work effort. This is a potentially powerful, yet unobtrusive, way to study physicians’ use of time. We used data on physicians’ time allocation patterns captured by over thirty-one million EHR transactions in the period 2011–14 recorded by 471 primary care physicians, who collectively worked on 765,129 patients’ EHRs. Our results suggest that the physicians logged an average of 3.08 hours on office visits and 3.17 hours on desktop medicine each day. Desktop medicine 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. Staffing and scheduling in the physician’s office, as well as provider payment models for primary care practice, should account for these desktop medicine efforts.