Computers create work...PO Day 153

We knew it, didn't we? We never did buy the idea that computerization saved time. We sit down at the machine for just five minutes and don't get up for an hour! It's turning out that is true with the Electronic Health Record system too.

In an October 2014 article in the International Journal of Health Services Drs Woolhandler and Himmelstein, New York Internists, analyzed and compared time spent by the average US doctor on bureaucratic tasks and job satisfaction. The following information is excerpted from their report.

The average doctor spent 16.6 percent of their work time on paperwork unrelated to patient care, in 2008, the last year that data was available. The data came from the 2008 Health Tracking Physician Survey of 4,720 physicians. The paperwork involved billing, getting insurance approvals for treatment, financial and employee management and contract negotiations. Paperwork that directly concerned patients such as writing notes in charts, ordering lab tests and writing to other doctors was not included in the paperwork estimation. "Paperwork" is used here euphemistically for computer work. So any time one sees "paperwork" you should read data entry on the computer.

The greater the amount of time a doctor spent in "administrative" paperwork the less satisfied he was with his chosen profession. Solo practitioners spent more time on administrative duties than did members of a group. Psychiatrists had the greatest burden of paperwork, followed by internists and General practitioners. Pediatricians spent the least time on non-patient tasks and were the most satisfied of doctors.

Now here is the come-away information: those using electronic health records, either solely or a mix of paper records and electronic records, spent more time on these administrative chores than did the doctors who used solely paper records. Proponents of EHR have maintained that computerization would reduce doctors' paperwork but it appears the opposite is true. Over the last two decades the

bureaucratic burden has grown for physicians. Fewer doctors are solo practitioners and many have moved into small group practices where bureaucracy rules.

Dr. Himmelstein commented: “Our crazy health financing system is demoralizing doctors and wasting vast resources.“Administrative work consumes one-sixth of U.S. physicians’ working hours and lowers their career satisfaction,” Steffie Woolhandler, M.D., M.P.H., and David U. Himmelstein, M.D. International Journal of Health Services, Vol. 44, No. 4.

The only rebut to these remarks is that they are based on a study from 2008. However, I have not had the sense that my doctors nor their staff are any happier with the amount of paperwork the EHR has created for them now.

Archive timeline: 2014: May and June - preparing for surgery, July - surgery and post op problems, August - recovery and physical therapy, September - thinking medically, October - getting back to normal, November - almost there!