As you are probably aware, most of your medical charts are maintained in electronic format. It is becoming increasingly rare for providers to rely on paper charts. If so, it is likely that provider is older and works for a small independent clinic. It is the case outside of the US too. There is a lot that we should like about electronic health records (“EHR”) – it should be easy to pull up a patient’s medical history, easy to communicate with other providers, easy to enter patient notes while s/he is talking. But, as we have seen, electronic health records may be a blessing wrapped in a curse. A recent paper highlights the different ways EHRs are used in the US when compared to non-US systems. The paper also suggests some of the continued causes of physician burnout from EHR use.  

The paper concluded that US clinicians spend a heck of a lot more time using the EHR for clinical activities and tasks than their non-US counterparts: 90 minutes on average per day v. 58.3 minutes. The study compared 348 US health systems and 23 non-US health systems. Of these 23, 10 were in the Netherlands, which is significant because the Dutch system is structurally similar to the US in its reliance on private insurers, private non-profit hospitals, and small private physicians’ groups.

The research suggests that part of the burden of time required by US providers is because of the adversarial relationship they have with payors. Many US payors look for reasons to deny payment for lack of proper documentation, so providers have been implicitly trained to over document every visit because they do not know which payor is covering the visit. So, while EHR has, in theory, made documenting easier, it has also caused a further uptick in provider stress in the techniques they have had to adapt to account for insurers’ instinct to deny payment.