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Electronic health records slow doctors down and distract them from meaningful face time caring for patients.

That is the sad but unsurprising finding of a time and motion study published in Tuesday’s Annals of Internal Medicine. A team of researchers determined that physicians are spending almost half of their time in the office on electronic health records (EHRs) and desk work and just 27 percent on face time with patients — which is what the vast majority of doctors went into medicine to do. Once they get home, they average another one to two hours completing EHRs.

I wish I could say I was shocked by these results. But they just add a fresh headline to old news, reinforcing what we already know too well: the more our country spends on traditional EHR software, the more time providers must spend on them, the more dissatisfied they become, the more frustrated patients feel, and the more expensive health care gets.


This is a shared problem with more than enough culpability to go around. Vendors like my company, athenahealth, and others have been required to develop EHRs that satisfy government regulations rather than the needs of providers and patients.

With limited authority and the best of intentions to oversee EHR certification and adoption, the Office of the National Coordinator for Health Information Technology continues to inflict enormous pain on our nation’s providers and care teams, turning caregivers into box-checkers and inadvertently limiting the private sector from innovating.


Motivated by more than $30 billion in incentives, vendors have lined up happily to ride the wave, building EHRs that satisfy government requirements but make it increasingly difficult and less rewarding to care for patients.

And so, we find ourselves in 2016 using the very latest stopwatches and journals to figure out just how bad our technology problem is. The very idea that we’re measuring 21st century technological performance with 19th century technology — the clipboard and stopwatch — is a nightmare of the absurd that only health care (or possibly Terry Gilliam) could conjure up.

Do you think Facebook or Amazon arms their teams with stopwatches to see how long a friend request or book order takes? They don’t. They look under the hood, constantly, to record user experience by the keystroke and they test fixes and changes in near real-time in a continuous feedback loop.

It’s time for health care to stop retreading old ground and instead embrace the kind of user-centric innovation pioneered by the likes of Amazon, Facebook, Uber, and other network-based revolutionaries. Network-enabled technology, which my company and clients run on, is still the radical exception in health care, even though it is the norm in many other industries.

While the athenahealth EHR is far from perfect, it doesn’t require a stopwatch to measure. We can and do track exactly how much time doctors spend documenting in the exam room with a patient or after hours at home. For example, we know that women physicians work on the EHR at night more often and longer than men. This isn’t self-reported information, as in the Annals article, but is directly measured.

One of our corporate scorecard metrics (which directly affect employee bonuses) this year is to decrease the amount of time physicians spend documenting patient visits after hours. Because our EHR is delivered over a network we know exactly how much time providers and staff spend on patient care vs. administrative work, and use that data to test and drive improvements.

This type of accountability needs to become the industry norm. Key measures like after-hours EHR documentation and time spent in face-to-face patient care will help squelch health care’s technology problem, bring transparency to the most offensive solutions in the market and, more important, will chip away at care team burnout and dissatisfaction.

Improving quality while reducing costs and delighting providers and patients is the Holy Grail. We will reach it only if we reimagine the existing health care process in which we are trapped. Efforts are in the works around the country to advance price transparency. Movements are slowly taking hold around value-based reimbursement. The call to break down health care data silos has been sounded. And initiatives to boost both physician and provider engagement are taking root. But when will we declare that the software-based EHR, as we’ve known it, is dead?

I’m starting the stop watch for this declaration now.

Jonathan Bush is CEO and president of athenahealth, a health care technology company based in Watertown, Mass., and author of the New York Times bestseller, Where Does it Hurt? An Entrepreneur’s Guide to Fixing Health Care.

  • This a very good article, and it is truly a shame that EMR systems are getting such a bad rap and less than a fair shake from doctors. As I see it, documentation has always been critical to patients health, and I would venture to say that electronic versus hand written should be better, less time consuming, and more accurate.

    I would not be adverse to discussing with the doctors what we can do to improve EMR systems to make it more adaptable, less time consuming and a tool as vital and useful to them as their pens and stethoscopes.
    So how do we make the Doctor’s lives easier and their time more efficient with the EMR Systems they are being asked to adapt? I would love to help.

  • Very good article and description of the current state. I would argue that the root of the problem is the “governmental” regulations- The Joint Commission and CMS. Health care providers of all types have to struggle to meet ever more nit picking documentation requirements; EHR companies respond accordingly to the demand. The tail is wagging the dog. TJC and CMS are are making life in health care miserable, for patients and those who care, or try to care,for them.

  • My sentiments exactly. I have embraced computer technology as a physician but am frustrated that the tools are archaic and slow. We need to have tools that assist us in medical decision making but not cripple our efficiency at the same time.

  • Hello…

    I must say as a patient I am truly saddened by the negative editorial in Tuesday’s Annals of Internal Medicine and the commentary in this article.

    Neither article mentioned an EHR vendor by name.

    Neither article outlined the complexity of pharmaceutical ordering and ancillary test ordering, which often must feed old ancillary computer systems. Ordering is a struggle for all EHR users and it should be looked at ways of improving the user experience.

    As an HIV patient I can tell you my provider struggles with Greenway and I refuse to use the associated Medfusion app because it is so bad to use.

    Let me be even more transparent. I have been an Epic Ambulatory Analyst for the past 10 years helping doctors with Epic.

    Back in 2005 providers would tell us medications were misspelled in the EMR only to their surprise they discovered they were misspelling them on paper their entire career.

    Pre-EMR Ambulatory Nurses may have been allowed to assist the providers with ordering but post-EMR some institutions make providers do all ordering.

    I am sure many lives have been saved due to EMR’s and I would encourage everyone to have an open discussion about key points that could be improved in health care without completely trashing EMR technology in opinion editorials.

    Thank you,

    John G Amero

  • Anything in excess can become toxic, like water, oxigen, vitamin D, etc. The EHR suffers from excesses in democracy and good intentions. Trying to satisfy every whim and desire of every constituency produced chaos.

    • I agree Joseph, merit in what you say. Politics can drive many things and the outcomes of that driving if even partially driven by ignorance can cause confusion and chaos (potentially), while it can also create a lot of good and good outcomes. I just don’t think this article accounts for the lags and interruptions in productivity that doctors /physicians/clinicians may suffer from while implementing such a massive undertaking especially when it comes to concurrent documentation, scale of 1-10 how much are you paying attention to the patient really (?) That being said, lags and decreases in productivity resulting are only temporary and not forever and the articles doesn’t seem to point this out.

  • EHRs as we know them need to be retired. I believe you are right on target when you call for user-centric innovation. Let the providers write notes that make sense to them and let intelligent algorithms cull out the data and put it to work for meaningful use, reimbursement, etc.

    • The challenge with entering text into an EMR in the way you would document a paper chart is that it is extremely difficult – if not impossible – from a data perspective to pull out the important information from a text/notepad style field. Everyone phrases a little differently, uses abbreviations, and have their own unique styles of documenting that in a paper chart can be translated when needed but the data can’t be pulled out of that text field without massive manual chart abstraction to understand the overall picture. Having discrete data fields in an EMR enables systems to process and share the information for analytics to really understand from a patient population what is happening with overall health. Having worked in the healthcare field for many years I’m dismayed that many comments here seem to miss the point – the goal is to improve healthcare. If you can’t pull out the data, you can’t truly see the forest for the trees. I’m not saying individual patient care is not important – far from it! But improving individual patient care frequently means understanding what the bell curve looks like. Is using an EMR exactly like documenting in a paper chart? No. And I don’t think that is a bad thing. Can it be improved? Of course! What can’t be improved. But I disagree with the “throw the baby out with the bathwater” approach to improving the situation. (Sorry for the cliches, but they seemed to me to fit…)

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