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.

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