News: Pandemic-shift to virtual care caused an increase in EHR use, study shows

A study published in the Journal of the American Medical Informatics Association (JAMIA) found that the shift to virtual care during the pandemic has driven clinicians to increase EHR use. Researchers found that clinician time spent in the EHR had dropped prior to 2020, but jumped back up with the COVID-19 pandemic, HealthLeaders reported. The increase was linked to more time spent reviewing clinical notes and answering messages from both colleagues and patients due to the shift from in-person to virtual care.

“The pandemic-driven shifts toward virtual treatment, and the corresponding change in patient expectations and awareness of communication tools such as secure messaging via the EHR, have substantially altered the nature of ambulatory care,” the study says. “Further, as telehealth and the pandemic incentivized patients to become familiar with the use of online portals to access their health information and connect with clinicians, the time required for those clinicians to manage the care of their patients through the EHR increased.”

“The long-term shift to a mix of face-to-face and virtual care, as ambulatory patient volume returned in the second half of 2020, may have exacerbated these issues as clinicians delivered care across multiple modalities in a single day,” the study adds. “Given that many of these changes, such as increased patient familiarity with asynchronous messaging, may persist beyond the COVID-19 pandemic, it is critical to evaluate how they have impacted clinician work.”

It suggests that while telehealth and other digital health tools and channels may improve access to care, health system leaders need to understand how that shift affects clinician workloads, which could negatively impact care and increase stress, HealthLeaders reported..

The challenge will lie in mapping out hybrid care strategies that reduce workloads while still improving care, meaning the EHR will need to be easier to use.

“Although near-universal adoption of EHRs was an important enabler of the shift to telemedicine, increased reliance on EHRs may exacerbate existing issues of low job satisfaction and poor well-being amongst clinicians,” the study pointed out. “Many clinicians spend a significant amount of time working in the EHR, and clinicians in the United States already face a greater EHR burden than their international peers. Total time spent working in the EHR, ‘after-hours’ time working outside of scheduled clinic hours, and responding to messages without protected time or reimbursement for [doing so] have been associated with a variety of negative impacts, including burnout, which can translate into higher costs and lower-quality care. Further, if the increased EHR burden is driven by activities such as messaging with patients, these new demands on clinician time may be concentrated on tasks that are outside of the bounds of the traditional ‘visit’ and are currently non-reimbursable for most clinicians.”

The researchers noted that policy makers should take these findings into account when developing coverage guidelines for virtual care.

“Policymakers and health system leaders looking to create sustainable workflows incorporating telemedicine in the post-pandemic period should be aware of these new demands on clinician time not only to avoid clinician burnout but also to accommodate rethinking the model of ambulatory medicine as patient expectations for care expand beyond the scope of the traditional face-to-face visit.”

Editor’s note: This article was originally published by HealthLeaders.