Primary care physicians drowning in EHR workload

Prior to and early in the COVID-19 pandemic, PCPs spent more time in the EHR and received more messages than physicians in other specialties, but it is unclear if the pandemic further accelerated the growth of PCPs' EHR workload.

Researchers observed EHR usage of 141 academic PCPs practicing family medicine, internal medicine, and general pediatrics within the University of Wisconsin-Madison health system, which cares for nearly 300,000 primary care patients per year. This longitudinal study compared the amount of time participating PCPs spent on EHR tasks during four periods across four years: May 2019–February 2020; June 2020–March 2021; May 2021–March 2022; and April 2022–March 2023. EHR time and inbox message volume were calculated for each PCP and normalized per 8 hours of scheduled clinic appointments. The volume of messages PCPs received increased significantly in May 2019–February 2020 and April 2022–March 2023 for three message types, including MyChart messages (+5.4 messages, 55.5%), prescription refills (+2.3 messages, 19.5%), and eConsults (+0.12 messages, 61.0%), while the volume of patient calls (–2.8 messages, –10.5%) and results messages (–0.3 messages, –2.7%) both decreased. PCPs spent nearly 30 minutes more (7.8%) on EHR tasks per 8 hours of scheduled clinic appointments between the pre-pandemic period (May 2019–February 2020) and the final year of the study (April 2022–March 2023). Time spent on EHR tasks outside of scheduled hours also increased by 6.4 minutes (8.2%) on days with scheduled appointments and 13.6 minutes (19.9%) on days without scheduled appointments.

What we know: For primary care physicians, completing EHR tasks and responding to patients' inbox messages take up a significant amount of time, often including working after-hours. Not only do such demands impinge on their clinical and personal time, they also put PCPs at risk of burnout and can factor into their decision to cut back on time in clinic or leave the profession.

What this study adds: PCPs' time in the EHR continues to grow. Although PCPs' inbox time may be stabilizing, it is still substantially higher than pre-pandemic levels. It is imperative that health systems develop strategies to change the EHR workload trajectory to minimize PCPs' occupational stress and mitigate unnecessary reductions in effective physician workforce resulting from the increased EHR burden.