EHR use among primary care physicians is on the rise

Key takeaways:

• The average time PCPs spent in the EHR in a workday increased by 28.4 minutes, or 7.8%, between 2019 and 2023.
• Orders also increased by 58.9% — a “particularly concerning” finding, researchers said.

Primary care physicians’ time spent on electronic health records substantially increased between 2019 and 2023, according to a study published in the Annals of Family Medicine.

Brian G. Arndt, MD, an associate professor in the department of family medicine and community health at the University of Wisconsin School of Medicine, and colleagues noted that PCPs spend more time in the EHR and receive more inbox messages than physicians in any other specialty.

Thus, “it is critical to understand how PCPs’ EHR workload has continued to change since prior to the onset of the COVID-19 pandemic,” they wrote.

To do this, the researchers conducted a longitudinal study of 141 academic PCPs over 4 years, from May 2019 to March 2023.
They found that, comparing the years before and after the pandemic, there was a 7.8% increase in the average time that PCPs spent in the EHR per 8 hours of scheduled clinic appointments.

There were further increases in PCPs’ time spent in:

• orders (58.9%);
• inboxes (24.4%);
• chart reviews (13%); and
• notes (2.3%).

Additionally, time spent in the EHR increased 8.2% outside scheduled hours on days with scheduled appointments and almost 20% on unscheduled days.

PCPs received fewer results messages (–2.7%) and patient calls (–10.5%) in the pre-pandemic period, but during the period of April 2022 to March 2023, they received significantly more:

• patient medical advice, or MyChart, requests (55.5%);
• electronic consults (61%); and
• prescription messages (19.5%).

Arndt and colleagues explained that the rise in orders is “particularly concerning, although it is unclear what has led to the increase.”

“One possibility is that the complexity of some MyChart messages and patient calls may be increasing as PCPs work with their patients to avoid visits,” they wrote. “This could result in PCP orders in these encounters that are not touched by other team members.”

The researchers pointed to a 2022 study that showed that more time spent in the EHR was associated with improved chronic disease and preventive care, but that was only primarily observed among PCPs with clinical full-time equivalents of 0.5 or less and below-average panel sizes.

“These findings suggest the cost of this increased EHR time may only be afforded by PCPs with lower clinical loads,” they wrote.

Arndt and colleagues concluded that solutions to decreasing EHR burdens “might include reducing inbox volumes through policy change, redesigning primary care workflows and teamwork, and resetting patient expectations.”

References:

• Arndt B, et al. Ann Fam Med. 2024;doi:10.1370/afm.3047.
• EHR workload continues to grow for primary care physicians. https://www.eurekalert.org/news-releases/1031565. Published Jan. 22, 2023. Accessed Jan. 18, 2023.