EHRs make it harder for surgeons to spend time with patients, study finds

The fact that electronic health records distract primary care physicians and clinicians from making eye contact with patients or engaging them in conversation is a well-trodden realization, but less has been discussed about the technology's impact on surgeons. It turns out, however, that implementing an EHR system at an orthopaedic clinic may have unanticipated effects on efficiency and productivity. 

Those, of course, include a temporary increase in labor costs and a lasting reduction in time spent interacting with patients, according to a new study published in The Journal of Bone and Joint Surgery. 

EHR usability, in fact, is a major issue in all areas of healthcare. Late last month Pew Charitable Trusts published a report stating that EHRs can not only yield workflow challenges that do not improve patient safety but, even worse, the software can actually contribute to patient harm. At the very least EHR and other technologies have been shown to play a big role in physician burnout as they spend more time clicking than talking to patients -- though there are a number of ways providers can innovate to combat  physician burnout, too, including deploying digital health tools. 

In the meantime, researcher in the Journal of Bone and Joint Surgery study found that even after an initial learning period, introducing a new EHR system may affect several aspects of clinic workflow, according to the paper, adding that the length of implementation is usually about six months.

Researchers used time-driven activity-based costing methods to evaluate how a new EHR system affected costs and productivity at two outpatient orthopaedic arthroplasty clinics. The analysis included detailed observations of 143 patient visits before implementation of the EHR system, and again at two months, six months, and two years after.

At two months after EHR implementation, total labor costs had increased significantly, from $36.88 to $46.04 per patient visit. The cost spike was related to increases in the time that attending surgeons spent per patient, from 9.38 to 10.97 minutes, and in the minutes that certified medical assistants spent on patient assessment, from 3.4 to 9.1.

For surgeons and medical assistants combined, the time spent documenting patient encounters more than doubled, from 3.3 to 7.6 minutes.

By six months after implementation of the EHR system, total labor costs were similar to costs in the pre-implementation period. From six months to two years, labor costs remained stable. Average weekly patient volume decreased for one of the surgeons studied, but remained stable for the other surgeon.

But the increases in time spent on documentation persisted, even after the initial learning period. This was accompanied by a significant reduction in time spent interacting with patients, from 14.65 to 10.03 minutes.

EHR systems are rapidly being adopted throughout the U.S. healthcare system, in part due to increased regulation. It can be costly, the authors said, and requires workflow redesign.

"This could suggest that providers ultimately were able to spend less time with patients as documentation requirements increased," they wrote. "If so, this could represent a negative trade-off for patient care and leave patients less satisfied."

Twitter: @JELagasse
Email the writer: jeff.lagasse@himssmedia.com