Every doctor I know has been complaining about the growing burden of electronic busywork generated by the E.M.R., the electronic medical record. And it’s not just in our imaginations.
The hard data have been rolling in now at a steady pace. A recent study in the Annals of Family Medicine used the E.M.R. to examine the work of 142 family medicine physicians over three years. These doctors spent more than half of their time — six hours of their average 11-hour day — on the E.M.R., of which nearly an hour and a half took place after the clinic closed.
Another study, in Health Affairs, tracked the activities of 471 primary care doctors over a three-year period, and also found that E.M.R. time edged out face-to-face time with patients.
This study came on the heels of another analysis, in the Annals of Internal Medicine, in which 57 physicians were observed directly for 430 hours. The researchers found that doctors spent nearly twice as much time doing administrative work as actually seeing patients: 49 percent of their time, versus 27 percent.
These study results hovered over my head as I worked through a recent clinic session, most of which felt devoted to serving the E.M.R. rather than my patients. It was the kind of day that spiraled out of control from minute one, and then I could never catch up. The kind of day, nowadays, that is every day.
Part of the issue is that there are simply more patients, most of whom are living longer with many more chronic illnesses, so each patient has many more health concerns that need to be taken care of in a given visit.
But the main reason that I can’t keep up is the E.M.R. Like some virulent bacteria doubling on the agar plate, the E.M.R. grows more gargantuan with each passing month, requiring ever more (and ever more arduous) documentation to feed the beast.
I try to spend as much time as I can directly focused on each patient, listening to what she is saying, thinking hard about her clinical situation. This is the essence of good medicine. But it’s not the essence of what makes the clinical enterprise proceed forward. In today’s medical world, nothing exists until the E.M.R. requirements are tended to.
The painful truth is that every minute I spend talking with my patient or doing the physical exam — that is, any time not spent on the E.M.R. — simply grinds down the progress of the day.
To be sure, keeping electronic records has benefits: legibility, electronic prescriptions, centralized location of information. But the E.M.R. has become the convenient vehicle to channel every quandary in health care. New state regulation? Add a required field in the E.M.R. New insurance requirement? Add two fields. New quality-control initiative? Add six.
Medicine has devolved into a busywork-laden field that is slowly ceasing to function. Many of my colleagues believe that we’ve reached the inflection point at which we can no longer adequately care for our patients. The E.M.R. isn’t the only culprit, but it’s certainly the heavy-hitter.
Medicine traditionally puts the patient first. Now, however, it feels like documentation comes first. What actually transpires with the patient seems like a quaint trifle, something to squeeze in among the primary tasks of getting everything typed into the E.M.R.