IBD specialists, nonphysician practitioners have greater EHR burden in gastroenterology
CHARLOTTE, N.C. — In gastroenterology practices, inflammatory bowel disease specialists and nonphysician practitioners experienced increased electronic health record burden, according to a presenter at the ACG Annual Scientific Meeting.
Data retrospectively collected through the Epic Systems Signal analytics tool showed both IBD specialists and nonphysician practitioners (NPPs) spent increased time in the EHR, and NPPs specifically spent an increased amount of time on patient medical advice requests.
“These findings shed light on an important but understudied issue within gastroenterology,” Aman S. Bali, MD, resident physician in internal medicine at Mayo Clinic in Jacksonville, Florida, told Healio. “Given the inexorable links between EHR use and provider burnout, as well as the expected shortages of gastroenterologists that await us in the coming decades, understanding how gastroenterologists interface with the EHR is essential to creating new safeguards and practice models to prevent burnout.”
According to Bali, most of the existing literature on EHR burden and related burnout has been primarily focused on the primary care setting.
“Very little has been done to investigate and describe how these issues may apply to gastroenterology practice, prompting our interest in investigating EHR usage at our institution using Epic’s Signal analytics tool to fill this knowledge gap,” Bali said.
According to the presentation, EHR data for GI providers from a tertiary referral center were collected monthly from January 2021 to June 2021. Primary measures included total time logged into the EHR, including outside regular hours; time spent on clinical review, documentation and in-basket management; and efficiency quantified through the system’s “provider proficiency profile” metric. The researchers further compared EHR use patterns across provider gender, sub-specialty and training.
Data included 33 providers (48.5% women; 69.7% physicians; 30.3% NPPs) representing more than 3,747 clinic days and 16,572 appointments. All NPPs were women, and physicians accounted for 60% of appointments.
The researchers found women vs. men spent more overall time in the system per day (151.4 vs. 78.4 minutes), more time completing messages (60.3 vs. 42.9 minutes) and closed a higher percentage of visits on the same day (69.3% vs. 43.5%; P < .05 for all). These data all lost statistical significance, however, when NPPs were excluded.
When looking at physician subspecialties, Bali and colleagues found IBD providers experienced more overall EHR time per day compared with those specializing in motility/irritable bowel syndrome, esophagus and advanced endoscopy (131.1 vs. 91.7 vs. 66.2 vs. 39.2 minutes, respectively), as well as more than twice the amount of time in clinical review per appointment and time outside scheduled hours. IBD specialists also reported the lowest provider efficiency profile score of the four specialties.
Regarding provider training, researchers found NPPs vs. physicians spent more daily time in the EHR and the in-basket (206.2 vs. 75.9 minutes; P < .001) and more time in clinical review per appointment (10.2 vs. 6.6 minutes; P < .05). Also, NPPs experienced more patient medical advice requests compared with physicians (7.3 vs. 3.7; P < .05) and spent more time completing these requests (70.9 vs. 43.3 minutes; P < .05).
“The most interesting findings were that IBD providers and NPPs, including physician assistants and advanced practice registered nurses, had an increased EHR burden at our institution,” Bali said. “For IBD providers, this took the form of increased time spent in the EHR performing clinical review per appointment as well as time outside of scheduled hours on evenings, nights and weekends. For NPPs this took the form of increased time spent in the in-basket and higher burden of patient medical advice request messages.”
Given these data came from a single center study, Bali suggested a primary step in future studies could be assessing EHR burden at different institutions and practices with varying patient care models and patient panel compositions.
“This way, we may be able to gather data about the overall EHR burden of gastroenterology providers and identify best practices to improve efficiency in the EHR,” Bali said. “Additionally, studies directly assessing indices of burnout amongst gastroenterologists could add useful insight about how much the EHR is impacting workplace stress and job satisfaction.
“The EHR has become ubiquitous over the last decade and with these changes have come increased interconnectedness between patients and their providers,” Bali continued. “As new generations of patients continue to grow up with ever-advancing technology at their fingertips, these expectations of connectedness are likely to increase. As the field grows to meet these challenges, understanding the EHR burden of gastroenterologists is crucial to maintaining a strong workforce, especially if certain providers such as IBD specialists and NPPs have higher burden than others.”
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Bali AS, et al. Clinical burden of EHR use amongst gastroenterology providers associated with differences in sex, providers subspecialty and provider training. Presented at: ACG Annual Scientific Meeting; Oct. 21-26, 2022; Charlotte, N.C. (hybrid meeting).