The implementation of electronic health records (EHRs) over the past decade has been a game-changer for improving and standardizing key components of our care from electronic prescribing to care pathways, for reducing treatment variation to alerts, for insuring appropriate medications, treatments, and diagnostic studies are ordered. But not everyone would want to hold a pep rally to celebrate the electronic health record, given how pediatricians feel about the time they spend looking at screens and clicking boxes rather than looking at their patients. Some believe that the EHR is a key contributor to clinician burnout and the possibility of making unintended errors in documentation or clicking the wrong test or medication. While data exists on just how much time clinicians who care for adults spend using the EHR with each of their patients, little exists on how much time we as pediatricians spend. Overhage and Johnson (10.1542/peds.2019-4017) provide a comprehensive look across pediatric specialties at how much of our days and nights are spent using the EHR in a new study we are publishing this month. The authors share with us a summary analysis of more than 20 million ambulatory patient encounters involving more than 30,000 physicians from 417 health systems who use the Cerner Millennium version of the EHR.
The authors found that, on average across all pediatric specialties, pediatricians spend 16 minutes per patient encounter using the EHR with most of this time used on chart review and documentation (chart review occupying at least half of that time). How does this average number compare when stratified by various pediatric subspecialties? The tables that accompany this study will easily answer that question whether you are a generalist or a specialist, with lots of interesting data findings from this time analysis of EHR usage. So, what are the take-home lessons that may lead to improvements on the time spent and meaningfulness of the time spent using an EHR with your patients?
To answer that, we asked Drs. Naveen Muthu (University of Pennsylvania) and Raj Ratwani (Georgetown) (10.1542/peds.2020-030965) to provide us with a commentary. They point out the strengths of this study but also some limitations as well in what the study can teach us (e.g. how these times using the Cerner EHR might compare to someone using an EPIC or other EHR system) and how the findings in this study may pave the way for improving usability and efficiency of EHR system performance which in turn could decrease the feelings of burnout that some experience using the EHR as much as they do. Log on to the link provided and learn more!