Physician time spent on electronic health records in alternative hospital care models

Abstract

Introduction: Increasing time spent on Electronic Health Records (EHR) for delivery of patient care is often cited as an important cause of healthcare provider burnout.1 During COVID-19, the pressure to lower bed occupancy rates led to new models of care to deliver healthcare in a hospital-at-home (HaH) model, or in a clinic-style setting sited at the emergency department in an ambulatory care team (ACT) model. We aim to see if these alternative models of care can reduce time spent on EHR. Materials and methods: Using published methods of time-driven activity-based costing in healthcare, we created a process map for the journey of a typical patient with uncomplicated rhabdomyolysis and hypertensive urgency using different models of care. The amount of time each healthcare provider spent on delivering care and its breakdown was estimated in consultation with experienced clinicians, nurses, and allied health professionals. We confirmed these times by observing the actual care processes. Results and discussion: In all conditions across all models, residents spend about 4 times more time on patients in total compared to consultants (Table 1). Residents spend a higher proportion of time (40% to 63.1%) on EHR compared to consultants (12.5% to 22.6%). Compared to conventional inpatient ward based care, residents spent a lesser proportion of time on EHR in alterative models (65% and 90% in HaH and ACT respectively). However, consultants spend a larger proportion of time on EHR in alternative models (1.5 and 1.3 times in HaH and ACT respectively).In the HaH model, both consultants and residents spend more time on EHR (12 mins vs 4 mins and 86 mins vs 65 mins) but a lesser proportion of time on EHR in the HaH model. This is likely due to the influence of commute time and extra time taken to screen for safety concerns in a new service model.In the ACT model, the total physician time spent on the patient is about half of that of the conventional model (61 min vs 127 min). The absolute time spent on EHR is reduced by 2.3 times in residents and 1.5 times in consultants compared to conventional care. The proportion of time spent on EHR for residents compared to conventional care is reduced (57.1% vs 63.1%). Conclusion: Alternative models of care influence physician time spent on EHR and overall time spent delivering care to a patient differently. The ACT reduces overall physician time and time spent on EHR, demonstrating its potential to increase the efficiency and cost-effectiveness of care and contribute to reducing physician burnout in the global context of a shrinking health workforce.