You can’t blame everything on paperwork. It accounts for only 6.5 percent of a small-practice family physician’s workday, according to a new study published in the Annals of Family Medicine. Still, if physicians could free up the 34 minutes on average they spend on paperwork every day, they would reclaim enough room on their schedules for two more patient visits a day, the study reports. By meticulously documenting how physicians spend their time, the study suggests how much time they can devote to seeing patients and how much time they might save by automating their practices with information technologies.

Susan A. Flocke and Andrew Gottschalk, researchers at the Case Western Reserve University School of Medicine in Cleveland, had medical students meticulously document the activities of 11 physicians on two randomly selected days in three cities in 2003. The students shadowed the physicians to track the time they spent on 55 activities, which fell into three broad categories: 1) face-to-face patient care, 2) work associated with a visit but not in the patient’s presence, and 3) work related to care of patients who are not present. The data in the study amounted to 21 days (one was discarded), including 611 patient visits and 12,180 minutes of physician work.

Flocke and Gottschalk found that the physicians spent an average of 54.9 percent of their 8.6-hour workday (not including about an hour of lunch and personal time) providing face-to-face patient care. They spent 14.5 percent of their day on Category 2 tasks such as writing or reviewing the visiting patient’s chart (6 percent), or writing prescriptions (1.2 percent). Category 3 tasks such as more doing chart work (8 percent) or reviewing lab results (2.8 percent), took up 22.9 percent of the day. The remaining 7.7 percent of the workday dealt with practice administration, such as hospital meetings (0.7 percent) or medical obligations outside the office, such as teaching (1 percent).

Clearly, the patients in the office command the lion’s share of a physician’s time, with 69.4 percent of the physicians’ time devoted to tasks in Categories 1 and 2. Still, the authors note, the measured time physicians spent on each patient visit (13.3 minutes) was much less than what physicians self-reported to the National Ambulatory Medical Care Survey in 2003.

“It’s possible that face-to-face time with patients has diminished over the past decade, while patient-related demands outside the examination room have increased,” the authors speculate, although they acknowledge a need to gather data over time to determine whether that is true.

If this hypothesis is correct, however, the question becomes, to what extent and how can information technology restore the time spent with patients? How deep can technology cut into those 34 minutes a day of paperwork, for example, which the authors defined to include activities such as completing encounter forms, billing sheets, forms for disability or school physicals, and arranging for tests and consultations?

While acknowledging that technology is not a panacea (clearly one cannot save more than 34 minutes of paperwork on average), the authors point out that adopting systems such as electronic medical records and electronic prescribing can reduce paperwork and provide time-saving decision support.

“Documenting, disseminating information to patients, and aiding with decision making are vital to providing good-quality care to patients and maintaining continuous healing relationships,” they write. “But office systems could help streamline the physician’s role in these tasks.”

The author of this column, David Orenstein, is a technology and business writer in Silicon Valley. If you have a question about a Computing Care column, email him at davealli@comcast.net.