EHRs Increase Administrative Work for Physicians

Electronic health records (EHRs) could actually increase the physicians’ bureaucratic burdens, which already consume one-sixth of their time, according to a study by 2 professors of public health at the City University of New York.

Steffie Woolhandler, MD, MPH, and David Himmelstein, MD, are also both internists in the South Bronx and lecturers in medicine at Harvard Medical School. In their study, published in the International Journal of Health Services, they analyzed data from the 2008 Health Tracking Physician Survey and found the average doctor spent 8.7 hours a week on administration. These takes exclude anything patient-related, such as writing chart notes, communicating with other doctors, and ordering lab tests.

Among the administrative tasks taking up 16.6% of a physician’s working time include billing, obtaining insurance approvals, financial and personnel management, and negotiating contracts. Surprisingly, they found that physicians using EHRs actually spent more time (at least 17.2%) on administration compared with those who only used paper records (15.5%).

“American doctors are drowning in paperwork,” Dr Woolhandler said in a statement. “Our study almost certainly understates physicians’ current administrative burden. Since 2008, when the survey we analyzed was collected, tens of thousands of doctors have moved from small private practices with minimal bureaucracy into giant group practices where bureaucracy is rampant.”

She added that under accountable care organizations, physicians are facing incentives to actually deny care, which drives up administrative work.

The authors compared the United States to Canada, where physicians spend far less time on administrative tasks. They attribute this difference to the fact that Canada’s billing is simplified and bureaucracy has been reduced under the country’s single-payer system.

“Our crazy health financing system is demoralizing doctors and wasting vast resources,” Dr Himmelstein said in a statement. “Turning healthcare into a business means we spend more and more time on billing, insurance paperwork and the bottom line. We need to move to a simple, nonprofit national health insurance system that lets doctors and hospitals focus on patients, not finances.”