Primary care clinicians use EHRs more than other ambulatory specialists

Clinicians in primary care spent more time using electronic health records compared with those in medical and surgical specialties, data from a cross-sectional study showed.

“Previous work has described EHR use patterns within specific specialties and time spent on various EHR functions during ambulatory patient encounters,” Lisa S. Rotenstein, MD, MBA, an internist at Brigham and Women's Hospital, and colleagues wrote in JAMA Internal Medicine. “However, there is less information available about differences in time spent on the EHR by specialty or the distribution of EHR activities across specialties.”

The researchers compared total and after-hours EHR use and types of EHR use among 351 United States ambulatory health care organizations that utilized Epic Systems for outpatient management between January and August 2019. The cohort made up most of Epic’s ambulatory care users, according to the researchers.

Rotenstein and colleagues reported that mean active EHR time spent each day totaled 115 minutes for primary care clinicians, 85.7 minutes for those in medical specialties and 45.6 minutes for those in surgical specialties. The mean active after-hours EHR time was 29.8 minutes daily, 26.2 minutes daily and 16 minutes daily for these same fields, respectively. These differences “between groups persisted on multivariable linear regression controlling for organizational characteristics,” the researchers wrote.

Data further showed that primary care clinicians spent the most mean active time — 51.5 minutes — on notes daily. Those in medical specialties expended the second-most amount of time (40.8 minutes) on notes daily, followed by the surgical specialties (22 minutes).

“Clinical review and orders represented the next two biggest areas of time expenditure,” Rotenstein and colleagues wrote. “Team and system messages were the predominant sources of messages.”

The researchers also reported that each day, primary care clinicians received 15 times as many messages regarding patient medications, five times as many messages from patients and more than twice as many team-derived messages than their surgical peers.

“The interspecialty differences we have identified are important given the known associations between administrative burden and clinician burnout,” Rotenstein and colleagues wrote. “Further investigation should seek to characterize the reasons underlying these differences and identify interventions that reduce the EHR burden.”