Yes, physician screen time is rising. No, common solutions aren’t working.

In the months that followed the onset of COVID-19, it was clear physicians would be spending more time using technology tools to communicate with patients. Years later, the trend hasn’t reversed – and strategies to alleviate the burden on physicians have yet to take hold. 

Earlier this year, a study in the Annals of Family Medicine – appropriately titled “More Tethered to the EHR” – found today’s primary care physicians spend more time within electronic health records than they did before the pandemic. Current EHR time amounts to roughly 30 more minutes per 8-hour day in the clinic, an increase of 7.8%, along with 20 more minutes of after-hours EHR time over the course of the week. That’s nearly 3 hours per week. 

Patient messages are a key contributor to additional EHR time. The study found the number of inbound messages from patients seeking medical advice has increased nearly 56% since February 2020. Likewise, the number of messages related to prescriptions has increased almost 20%. 

The authors said three factors explain the increase in messages.  

• Portal use has risen. The Office of the National Coordinator said 73% of Americans were offered access to a portal as of 2022, an increase from 59% in 2020.  
• The shift to virtual care at the beginning of the pandemic likely led patients to expect faster responses to messages. (Not coincidentally, inbound phone calls dropped more than 10%.) 
• The 21s Century Cures Act requires providers to release test results to patients as soon as they’re available. That often leads to messages from patients who have questions. 

“With high demand for asynchronous patient care,” the authors concluded, “it is imperative health systems develop strategies to change the EHR workload trajectory.” Thus far, two popular options – deploying artificial intelligence and billing insurance (or patients) – have had little impact. 

Some health systems have turned to generative AI to help physicians draft responses to patient messages. A recent study in the Journal of the American Medical Association noted they can assist with non-urgent messages such as refill requests, clarity on test results, and general questions. 

Unfortunately, the JAMA study concluded generative AI didn’t save physicians’ time. While use of generative AI was associated with a 6% decrease in reply time, it contributed to a 22% increase in reading time. This stemmed largely from the need to make “substantive” changes to replies the tool generated, either to remove clinical advice outside of the scope of a response or provide key details the automated response lacked. One physician in the study noted generative AI responses were “overly focused on recommending appointments.” 

Other systems are encouraging providers to bill for reading messages. The Centers for Medicare & Medicaid Services approved billing codes to reimburse providers for “online digital evaluation and management services” in 2020. To qualify, providers must be working with an established patient, the patient must initiate the service, and the problem must require the attention of a qualified health professional. A Peterson-Kaiser Family Foundation analysis found insurance covered the full cost of 82% of claims, which averaged $39. Patients with out-of-pocket costs paid roughly $25. 

Last year, The New York Times, The Washington Post, and NPR reported high-profile health systems were charging patients for sending messages, purportedly to reduce message volume. So far, this hasn’t stopped patients, as a JAMA paper found fees contributed to a modest 2% decline in inbound messages.   

Nor are physicians embracing the opportunity to submit claims; JAMA also indicated they only bill for about 3% of eligible messages. Critically, the authors suggested providers seem wary of doing additional work to submit claims simply for responding to messages. 

Brian Eastwood is a Boston-based writer with more than 10 years of experience covering healthcare IT and healthcare delivery. He also writes about enterprise IT, consumer technology, and corporate leadership.