Computer vs. patient: Fighting for residents’ attention

It’s no secret that doctors spend increasing amounts of time in front of computers rather than patients.

But what does this mean for medical trainees? That question is at the heart of a new study by Stanford researchers, who sifted through more than three years’ worth of data in electronic health records, analyzing nearly 16 million interactions to find out how internal medicine residents at one hospital were spending their time.

The study was published online Feb. 6 in PLOS ONE. The senior author is Jonathan Chen, MD, PhD, assistant professor of medicine. The lead author is former Stanford undergraduate student Jason Ku Wang.

The researchers discovered that the trainees spent an average of 5.38 hours — or nearly half of a 12-hour work day — in front of a screen. The findings correspond with what previous studies, conducted through observations and questionnaires, have found. But because their work analyzed computer records, the Stanford researchers could drill deeper.

“We were able to pinpoint more precisely what specific actions they were taking,” Wang said, “so whether they were looking at a patient chart, or whether they were inputting new information — writing a note or ordering a lab test.”

The researchers found that chart review accounted for the largest proportion of computer activity by all residents, followed by note entry. That meant they were spending more time looking for information than adding new information — an insight that might be helpful for vendors and educators, Wang said.

“I know a lot of effort has been put into decreasing the amount of time physicians spend writing a note,” he said. “Perhaps they could also look at improving EHR design so that information is easier to access.”

It’s very alarming to see that almost 50 percent of your day will be spent on the computer rather than with a patient.

The study also identified a behavioral difference between residents based on the clock: While night workers stopped their EHR activity promptly after their shift ended at 7 a.m., trainees working days tended to continue computer work up to 9 p.m. and beyond.

The variance might reflect understandable feelings of fatigue related to night work, Chen said, but it also could indicate that day-shift residents feel a different level of ownership than their counterparts when it comes to their patients — and that today’s residents have a better means for bringing their work home.

“Doctors used to be done with work at work,” he said, “but now they need to keep logging in, checking in, filling in that note or doing this other paperwork that still requires attention.”

Not all computer time for doctors is bad, Chen said, but much work needs to be done to ensure that hours in front of the screen translate to effective care.

Although he is a self-described “computer nerd,” Chen said he still finds value in face-to-face patient interaction and even in paper charts. As a resident at a hospital without a digital record system, Chen said he spent more time in patients’ rooms than at a computer console, and he discovered that his notes were more efficient when he had to use a pen. “You want to write as little as possible,” Chen explained. “Just the relevant information.”

Wang, who has plans to attend medical school next fall, said he was a bit concerned by what his own research showed. 

“It’s very alarming to see that almost 50 percent of your day will be spent on the computer rather than with a patient,” he said. “That’s definitely not what most of us go into medicine hoping for. But on the other hand, information, if it’s high-quality, can be very useful and very promising: Precision medicine and personalized health care are rooted in having electronic health records that can make that data available. For me right now, it’s very interesting because I think it’s unclear whether the electronic health record as it’s currently designed will prove to be more harmful or productive.”