Working-Late

Has EHR Increased Your After-Hours Workload?

One of the comments we hear from clinicians who have implemented an EHR is the impact on their after-hours workload, whether this be in the clinic at the end of the day or at home in the evenings. This feedback is not limited to specific EHRs and tends to be a more widespread issue. The following comments were submitted by physicians who completed the AmericanEHR Partners EHR satisfaction survey:

  • I can get through my day, but I spend an extra hour to two hours longer at the office than I used to prior to our implementation of the EHR. This is really bothersome to me.
  • It makes a 15-minute visit take 2–3 times as long.  I’m not sure I’ll ever be able to get back to my pre-EMR volume.  Some nights, if I have a meeting after work, I’m up working on charts until 1 am!  And that’s only working at 80% of my previous patient volume!  There has to be a better way… talk about burnout.
  • Radiology reports are now coming across through an interface, but we are unable to see images — for this we must log onto a remote desktop for the hospital in a separate application. I am routinely having to finish charts at home after work.
  • I see fewer patients. I spend a few hours at the end of the day finishing entering data. I never had to do this with paper charts.

There are number of potential reasons for challenges with documentation and decreases in efficiency including the following:

  • Lack of familiarity with the EHR software and inadequate training. In a survey conducted by AmericanEHR Partners in 2011, (The Correlation of Training Duration with EHR Satisfaction: Implications for Meaningful Use), nearly half (49.3%) of respondents indicated that they received three or fewer days of training. EHRs are complex software applications that require familiarity for efficient use, which should be facilitated by adequate initial and follow-up training.
  • Usability problems with the EHR software that require too many clicks in order to perform specific functions or a limited number of mechanisms to enter data into the EHR.
  • Poorly designed or deficient templates that slow down the collection of information for specific conditions or types of encounters.
  • Inadequate ability to exchange information electronically with other systems (e.g. Labs/Diagnostic imaging) or providers (e.g. Referrals/Consultation reports) resulting in a dual electronic and paper practice process.

What are your experiences using an EHR? Have you returned to or exceeded efficiency levels that you had reached with paper charts? Do you have advice that you can offer other clinicians to improve their efficiency and reduce after-hours workload?

Comments:

11 responses to "Has EHR Increased Your After-Hours Workload?"
  • November 16, 2012
    Allen
    said:

    I consider it extremely important to choose an EMR system that does not require a specific work-flow to produce each chart note. Not all visits require a review of Family History, for example. However, many systems require you to at least click through a variety of screens if only to accept their entries.
    Also, being able to see all fo your work for all of the visit problems is critical to efficient use of the EMR. If you program hides “Problem #1” while you are scrolling through the half dozen screens to document “Problem #2” you will find your efficiency suffers, since patients rarely give you their complaints/findings in an organized manner.

  • November 18, 2012
    Joseph J. Muscato, M.D.
    said:

    I certainly feel that this is the case. (I am finishing some up this weekend!) Meaningful use has added multiple lists I need to click through, including re-affirming all office visits even after I dictate. Recently added were clicks re last mammogram, last colonoscopy, confirmation of “inbound” and “outbound” referrals including records sent, smoking counseling, etc.

  • November 20, 2012
    e. Lernhardt
    said:

    Just reading the chart notes from ER or hospital could make me cry!
    Pages and pages of repetitive nonsense and the actual life saving information is not there! We are aproaching the EHR tower of Babylon, where communication is impossilble. Why can we not have a single platform and technology like Taiwan?

  • November 23, 2012
    Marta Jacenyik MD
    said:

    My workload is now at least two hours longer a day, 3 months after implementing Athena , (after switching from 5 years of Amazing charts which was faster to use for regular charting but didn’t do meaningful use Stage I well ) and no improvement in sight.

  • December 8, 2012
    John
    said:

    Occasionally we have a patient come to the office from the pre-EHR (3 yrs ago) days. For them, we are first handed the old paper chart from the back room files before beginning their note.
    What a difference! The paper charts were simple, accurate, quick, and streamlined. All the things the behemoth “Practice Partner” system claimed to be. I long for the days of the paper chart.
    The sad fact is that EMR in its present state is inefficient, dangerous, and uses 3 times more paper than our paper system ever did. It is the perfect example of what happens to a system when it is overtaken by bureaucrats and self-serving paper pushers.

  • January 7, 2013
    Jonas Söderström
    said:

    You might be interested in this Swedish study of physicians, showing a very strong correlation between severe stress and “chores”, administrative tasks perceived as unnecessary. It’s “an increase in risk that is rarely shown in occupational studies”, the researchers say.
    http://stupidsystem.org/2013/01/07/new-chores-hits-self-esteem-in-doctors/

  • Pingback: Overworked from Electronich Health Records (EHR) | Stupid **** system!

  • Pingback: ”I long for the days of the paper chart” : Jävla skitsystem!

  • March 22, 2013
    Ralph P Eccles
    said:

    Big companies always use Epic (at least in our state) and they have 46% of the market share for large multi-specialty practices. They must do a great job of marketing to the CFO, but they have no communication with the physicians actually using the cumbersome system. There is no way to contact the vendor.

    Epic is especially difficult in Endocrinology and especially if the pt has multiple problems that need to be reviewed and addressed. Complex patients can never be put into a template.

    I have gone from 22 pts per day with paper and dictation to 8. My chart note has gone from 2-3 pages to 8-10. The referring physicians have to wade through pages to find the synopsis and recommendations that I have dictated into the chart using Dragon Medical – which has an accuracy rate of almost 95%, but that is a lot of retyping on a long HPI or Assessment/Plan

  • July 4, 2013
    Jim E
    said:

    Our group has concerns that given the changes and requirements of EHR coupled with never-ending demands of seeing even more patients daily by our “overseers”, then when will our first malpractice claim be served as a result of our evolving “operator fatigue”?

  • September 18, 2013
    CAP
    said:

    The real issue here that is not being talked about is the number of patients doctors attempt to see in a day. Even with paper, ours got hours behind. Now put new system and method of documenting in front of them of course it will slow them down. for a time only hopefully. But when you have a doc trying to see 40 patients in a half day and use the new method – good grief!! CMS could care less how many patients you see they just want to be able to audit what you did and say you did according to the $ they paid them. Hence the reason for accountability. Decrease your number to provide accurate documentation and not have to take home work, sorry just how it is…

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