Physicians are evenly splitting their time between office visits with patients and “desktop medicine” activities like typing notes, ordering tests and making referrals through a patient’s electronic health record (EHR), according to a study published in the April 2017 issue of Health Affairs.

The study, led by Ming Tai-Seale, PhD, MPH, associate director of the Palo Alto Medical Foundation Research Institute, examined EHR transactions for 471 primary care physicians from 2011 to 2014.

Their results were doctors used their EHRs an average of 3.08 hours per day for office visits and 3.17 hours per day for desktop medicine. In the study period, the amount of time logged on patient visits decreased while more time was being spent on those desktop tasks.

“This is one of the first studies to use EHR access logs that identify discrete, time-stamped activities to account at least partially for how physicians allocate their time,” Tai-Seale and her coauthors wrote. “The time recorded for desktop medicine corroborates previous reports of the extensive time spent by physicians on activities outside of direct face-to-face visits.”

The study references earlier work quantifying how EHRs have affected physicians’ time spent with patients. A recent American Medical Association observational survey found doctors are dedicating almost 20 percent of their day to tasks other than face-to-face clinical time with patients.

Rather than focus on the common topic of EHRs causing physicians to feel burnt out, the study discussion centered on their compensation. Many of the desktop medicine activities, the authors wrote, aren’t factored into reimbursements under fee-for-service contracts.

“Many of those activities—such as care coordination and responding to patients’ e-mail—are of high value to the delivery system and to patients, so the staffing, scheduling, and design of primary care practices should reflect this value,” Tai-Seale and her coauthors wrote.

That may change, the researchers concluded, under the new payment tracks being introduced as part of the Medicare Access and CHIP Reauthorization Act (MACRA). The tracks “explicitly move away from payments for visits only” and acknowledge the parts of care outside of visits require “appropriate compensation.”