Switching between telehealth, in-person visits the same day adds to PCPs’ EHR workload

Key takeaways:

• On days when telehealth accounted for 26% to 99% of visits, providers spent 15 more minutes on the EHR.
• Extra EHR time did not extend into the next day, meaning providers may have worked longer on hybrid days.

Clinic days with both telehealth and in-person visits were tied to increased electronic health record work for primary care providers, a study in JAMA Network Open showed.

“We wanted to get some empirical evidence out there on the EHR time costs of telemedicine relative to in-person visits,” Nate C. Apathy, PhD, an assistant professor of health policy & management at the University of Maryland School of Public Health, told Healio. “We were hearing from providers how much more efficient they felt being able to author the note while in the telemedicine visit, so we wanted to see if that was true on average.”

Apathy said he and his research team also wanted to explore the idea of “switching costs” between in-person and telehealth visits, “since telemedicine visits are fundamentally a different kind of communication.”

“So, if you’re conducting different types of visits throughout the day, it’s like going back and forth between in-person and Zoom meetings, and that takes a different kind of cognitive toll on you than days with all in-person meetings,” he said.

Apathy and colleagues assessed EHR use among 316 PCPs across 67,894 days and then calculated their percentage of daily telehealth use.

On average, PCPs spent 71.3 minutes on documentation during days with zero telehealth visits and 87.1 minutes on days with up to 10% of visits through telehealth.

Compared with days with zero telehealth visits, days when PCPs conducted 26% to 99% of visits through telehealth were associated with a:

• 5.6% increase in minutes of active EHR time, translating to an additional 14.8 minutes;
• 6% increase in documentation minutes, translating to an additional 4.7 minutes; and
• 6.2% increase in medical record review minutes, translating to an additional 5.5 minutes.

“My interpretation of the results is that we are seeing increased EHR time on mixed-modality days because of the multitasking that doctors are doing in telemedicine visits that they are unable to do in person,” Apathy said. “We could also be seeing increased EHR time on those days because for telemedicine visits, doctors generally have less support staff doing any information gathering prior to when the physician arrives in the ‘room.’ So that work has to fall to someone, and for most telemedicine visits, the doctor is the only one.”

The researchers also found that the added EHR work did not continue into next-day documentation.

“That’s important because it implies that all of this added EHR and documentation time is being absorbed into the same day as the visits are occurring, which may mean later evenings for these providers on days where they have both telemedicine and in-person visits,” Apathy noted.

Fully telehealth days were not associated with greater EHR work, contrasting with prior research. The researchers attributed this finding to their small sample size of fully telehealth days.

According to Apathy, the most notable implication of the findings is scheduling.

“We show that these mixed-modality days or weeks add nontrivial EHR time to physicians’ workload. That means that we can’t just assume that a 10-minute telemedicine visit only takes 10 minutes and we can pack three of them in every 30-minute slot on a physician schedule,” he said. “There are additional costs in terms of documentation time and switching costs that these telemedicine visits require, so providing time in provider schedules to accommodate those added tasks is important.”

For more information:

Nate C. Apathy, PhD, can be reached at nca@umd.edu.