Telehealth Linked to Physician EHR Burden

Telehealth is great for a lot of things, but reducing physician EHR burdens isn’t one of them, according to a new study in JAMA Internal Medicine

Researchers analyzed the EHR metadata of 1,052 ambulatory physicians at UCSF Health over 115 weeks straddling the onset of the pandemic, comparing usage from August 2018 – September 2019 to August 2020 – September 2021.

They found that telehealth use correlated to more time spent in the EHR both during and outside of patient scheduled hours (PSHs), although the extra work was mostly related to documenting visits rather than messaging patients.

  • Comparing the pre- and post-pandemic windows, telehealth use increased from 3.1% to 49.3% of all encounters.
  • Time spent working in the EHR during PSHs increased from 4.53 to 5.46 hours for every eight PSHs.
  • Time spent working in the EHR outside of PSHs increased from 4.29 to 5.34 hours for every eight PSHs.
  • Weekly messages received from patients increased from 16.7 to 30.3, and messages sent to patients increased from 13.8 to 29.8. Despite the spike, further analysis showed that documentation added the bulk of the extra time rather than messaging.

The authors give several explanations for why telehealth might be leading to more time in the EHR, including the fact it allows the physician to compose the note throughout the encounter (instead of a shorter burst afterwards).

  • That still wouldn’t account for the increase in EHR time outside of PSHs, which the authors believe might be because telehealth improves appointment adherence and reduces the time between visits that was previously used for documentation.
  • It could also be that telehealth requires more before-visit EHR review in the absence of a physical examination.

The Takeaway

There’s plenty of research suggesting that telehealth reduces provider burnout, but this study adds a wrinkle to the underlying explanation. These results make it clear that telehealth isn’t reducing EHR time, which points to other benefits like convenience driving lower burnout, such as more flexibility, autonomy, and even engagement with work.

Allscripts Sells Hospital EHR Segment for $700M

The quickly shifting EHR landscape saw another major move last week following Allscripts’ announcement that it is focusing its offerings by offloading its hospital EHR assets to Harris Computer, a subsidiary of Canada-based holding company Constellation Software.

Harris is set to acquire Allscripts’ Hospitals and Large Physician Practices business segment for $670M, plus an additional $30M tied to the segment’s performance in the next two years.

  • The transaction includes Allscripts’ Sunrise, Paragon, TouchWorks, STAR, Opal, HealthQuest, and dbMotion solutions, which together accounted for $928M of the company’s $1.5B total revenue in 2021, but have also been steadily losing market share.
  • The $700M valuation implies a 4.8x multiple on the hospital EHR segment’s expected earnings for this year, not particularly high given that other publicly traded EHR companies command an average multiple of over 10x, which reflects two consecutive years of shrinking revenue with another decline forecast for 2022.
  • By divesting the contracting division, Allscripts can now “maximize focus” on its healthier service lines like the Practice Fusion EHR for small practices and the Veradigm analytics solution, which has faster growth (up 4.6% to $552M in 2021) and healthier margins than the legacy EHR business.
  • Veradigm houses one of the largest EHR-linked patient databases available for research, transforming data from Allscripts’ clients into insights that help connect providers and payors to life sciences companies. The data flow won’t be affected by the hospital EHR division’s new ownership, and the platform will now serve as the core of the company’s operations moving forward.

The Takeaway

Allscripts has been committed to refining its offerings since posting a wide net loss in 2019, a process that included similar sales of its 2bPrecise genetic research arm and its CarePort patient coordination services. Offloading the business segment that generates a majority of its revenue highlights just how committed Allscripts is to focusing its portfolio on high growth areas, and the uptick in the company’s stock price following the announcement is a good indication that investors agree with that strategy.

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