How Physicians Spend Their Work Time: an Ecological Momentary Assessment

Background Little is known about how physicians spend their work time. Objective To determine how physicians in outpatient care spend their time at work, using an innovative method: ecological momentary assessment (EMA). Design Physician activity was measured via EMA, using a smartphone app. Participants Twenty-eight practices across 16 US states. Sixty-one physicians: general internal medicine, family medicine, non-interventional cardiology, orthopedics. Main Measures Proportions of time spent on 14 activities within 6 broad categories of work: direct patient care (including both face-to-face care and other patient care-related activities), electronic health record (EHR) input, administration, teaching/supervising, personal time, and other. Key Results After excluding personal time, physicians spent 66.5% of their time on direct patient care (23.6% multitasking with use of the EHR and 42.9% without the EHR), 20.7% on EHR input alone, 7.7% on administrative activities, and 5.0% on other activities (0.6% using the EHR). In total, physicians spent 44.9% of their time on the EHR. Limitations Unable to measure time spent at home on the EHR or other work tasks; participating physicians were not a random sample of US physicians. Conclusions The efficiency of highly trained professionals spending only two-thirds of their time on direct patient care may be questioned. EHR use continues to account for a large proportion of physician time. Further attempts should be made to redesign both EHRs and physician work processes.