A fantastic new study 😉 has once again documented the incredible burden of EMRs on U.S. family physicians. Researchers observed 982 family physician-patient encounters in clinics associated with 10 family medicine residencies. They recorded the times required for the physicians to complete each clinic visit. They did not record times for tasks not associated with the observed encounters such as answering pages and filling out other forms.

The researchers found the average total time for the clinic work was 35.8 minutes per visit, 16.5 minutes of face time with the patient, and 18.6 minutes of the visit was spent in the EMR. The doctors often worked over lunch, stayed late after all the patients were gone, or took work home. One of these occurred in 65% of the visits, and average of 6.9 minutes per clinic visit.  The number of minutes per visit increased by about 3 minutes per issue addressed up to 6 issues, then plateaued.

The results of this study are very similar to a study of EMR time stamps at clinics in Wisconsin. A difference in the WAC time (work after clinic) was less in the Wisconsin study, because it only measured time at home after hours. This study captured WAC that happened during the day, which likely explains why the total minutes per day on WAC were higher in this study.

To put this in some perspective, a recent study in the U.K. found that the average GP visit includes 3 minutes of EMR time. Why the difference? The UK EMRs are devoid of most of the baggage that comes with U.S. EMRs, which have been built to please the finance office, the purveyors or meaningless quality metrics, and the excessive and burdensome Medicare documentation rules (that all the insurance companies use as well).

Even if we remain stuck with the Medicare/CMS documentation rules, the original formula used to develop the CMS payment valuations assumed that 71% of the doctor’s time was spent in face time with the patient, not less than half as was measured here.

The AAFP has recently announced a program to reduce administrative burdens on family physicians, but it says nothing about taking the EMR stone off our backs. Starting with the Future of Family Medicine Project, the inner sanctum of the AAFP has been complicit in forcing these horribly expensive and horribly klunky devices into our clinic work. It’s time for the AAFP to let out a big scream, “Sorry, we really screwed that up!” and lead the way to undoing the damage EMRs have caused.

But just like my children who can’t take their thumbs off their video games and devices, AAFP leadership can’t extricate themselves from their computer screens. As a result, billions of dollars per year continue to be wasted, the morale of family physicians continues to erode, and our patients and our society suffer for it.