By Christina Frangou

Ask any surgeon how much time they spend on their hospital’s electronic health record and the answer is likely to be the same: too much.

For the first time, researchers have looked at how many hours per day that general surgeons spend dealing with their hospital’s EHR. The number is an average of 1.95 hours every day of the week, with some surgeons regularly spending nearly five hours daily. The heaviest EHR use by surgeons occurred on clinic days, and the lightest was on Saturdays.

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All surgeons took EHR work home with them, with a measurable increase in remote use occurring on nights and weekends.

“We hope to raise more awareness about how our time is spent as we care for patients,” said Morgan Cox, MD, a general surgery resident at Duke University Medical Center, in Durham, N.C.

Dr. Cox and her colleagues studied 20 female and 31 male surgeons working in the Department of Surgery at the center between 2016 and 2017. They did not capture EHR use at Veterans Affairs hospitals or physician logins from portable devices, so the study underestimates overall EHR use.

Investigators tracked surgeon login and logout time stamps from the Epic EHR (Epic Systems) and compared them with time schedules from the department. Results showed the following:

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  • Surgeons spent a mean of 1.96 hours per day on the EHR.
  • This duration rose to 2.47 hours on workdays and fell to 0.70 hours daily on weekends.
  • The top 15% of EHR users logged nearly twice as much time as other surgeons, spending a mean of 4.6 hours on workdays and 1.49 hours on Saturdays and Sundays.
  • All surgeons spent time on the EHR after leaving the hospital. Of all EHR use, 13% occurred after hospital work hours and 35% was done remotely.

Even though the study is the first to look specifically at EHR use by practicing surgeons, the results are not surprising. Physicians across specialties say they spend hours each day, even after work hours, on the records. A 2017 study found that family physicians spent nearly six hours in an 11.4-hour workday—more than half their working time—dealing with documentation (Ann Fam Med 2017;15[5]:419-426).

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Physicians say they are frustrated that the time dedicated to the EHR often feels like time wasted because of poorly designed technology that prioritizes billing over patient care or physician time.

Doctors voiced their dissatisfaction loudly in a survey of 30,000 physicians, published in Mayo Clinical Proceedings (2020;95[3]:476-487 ). They gave EHRs an overall grade of F for usability.

“That is not shocking to me, but it should be a cause of alarm. Why are we accepting something in health care with F-level performance?” said Lillian Erdahl, MD, a clinical assistant professor of surgery at the University of Iowa Carver College of Medicine, in Iowa City. She was not affiliated with the study.

Dr. Erdahl and other surgeons pointed out many design flaws in EHRs, including frequent alerts that are not relevant to a patient’s care, leading to “alert fatigue”; inaccuracies in patient histories that are repeated by using the copy-and-paste function throughout a chart; and crucial information that is locked behind dozens of clicks.

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These frustrations exacerbate physician stress levels and burnout, research has shown. Another study looked at physicians in a multispecialty practice and found that doctors who received a higher number of in-basket messages by the EHR were more likely to experience burnout and had an increased intention to reduce their clinical workload (Health Aff [Millwood] 2019;38[7]:1073-1078).

The rapid adoption of EHRs in the United States occurred despite the technology and not because of it.

Today, EHR systems are present in more than 95% of hospitals, up from about 9% in 2008. This uptake was spurred by policy changes, such as the American Recovery and Reinvestment Act, which poured $49 billion into adoption of EHRs, and the monetary penalties instituted in 2015 via the Medicare EHR Incentive Program.

Despite this mass adoption, usability remains low. Physicians and other health care workers are burning out, leaving their practices, and taking their own lives at alarming rates. “This is a crisis in our practice, and resources must be put in place to address it,” Dr. Erdahl said.

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Health care organizations need to commit more time, money and personnel to reducing the burdens on physicians, she said. Efforts are underway to improve technology to support EHRs. Amazon recently introduced a virtual medical scribe, Amazon Transcribe Medical, which can transcribe doctor–patient interactions and upload the text straight into the medical record. Nuance Communications Inc., together with Microsoft, and Google also are working on developing their own “digital scribes.”

“Whatever they are, changes cannot come soon enough,” Dr. Erdahl said.