SHM board member Eric Siegal, MD, SFHM, wasn't surprised by the findings in a new report in the Journal of General Internal Medicine that found medical interns spent just 12% of their time in direct patient care and a whopping 40% of their time using computers.
"There certainly are advantages to electronic health records (EHRs), but one of the clear consequences is that it's impossible to function in the hospital without spending a lot of time in front of a computer screen. EHRs have turned physicians into secretaries," says Dr. Siegal, medical director of critical-care medicine at Aurora St. Luke's Medical Center in Milwaukee. "Work that we used to hand off to a unit clerk or to somebody else to do has now dropped into our laps."
Dr. Siegal and two of the authors of "In the Wake of the 2003 and 2011 Duty Hours Regulations, How do Internal Medicine Interns Spend Their Time?" agree that the growing EHR presence means that hospitalists and other internists spend a significant amount of time on data input and management, potentially at the cost of other activities. The observational study, which tracked general medicine inpatient ward rotations at Johns Hopkins School of Medicine and the University of Maryland, both in Baltimore, found that interns spent 64% of their time in indirect patient care, 15% in educational activities, and 9% in miscellaneous activities.
"We've created the perfect system to give us these results," says John Hopkins hospitalist and senior author Leonard Feldman, MD, FACP, FAAP, SFHM. "We need to place a value judgment as a medical community on whether these results are what we want our training programs to look like."
Dr. Feldman says EHRs need to be more efficient than current iterations, which focus more on data collection.
"I have been remarkably unimpressed with how many EMRs organize data and how surprisingly difficult it is for us to efficiently glean and prioritize information that we need to make decisions," Dr. Siegal adds.
Study lead author Lauren Block, MD, also of Johns Hopkins, says increased efficiency with EHRs is just one pathway to more direct patient care. Another is focusing on improving how physicians interact with the patients. She says teaching medical interns how to make the most of the time they have with patients—including digital interactions—is the next step toward improving the patient experience.
"It's not just the quantity of time, it's the quality of time," Dr. Block says. "Medical education has to find a way to address that and make sure that all the various modes of communication we use with patients are done well, and done in a manner that's safe, respects patients’ privacy, and meets patient needs."