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.