Doctors are spending more time communicating online with patients, viewing test results and updating electronic health records than they do seeing patients in person.

That’s the takeaway from a new research report from the Palo Alto Medical Foundation Research Institute in Palo Alto, Calif.

For the study researchers looked at 31 million electronic health records transactions recorded by 471 primary care physicians, who collectively worked on 765,129 patients’ electronic medical records from 2011 through 2014.

The study found that time spent by doctors dealing with patients online and updating electronic health records was slightly more than the time they spent seeing patients in person.

Over the course of a typical day doctors logged an average of 3 hours and five minutes on office visits and 3 hours and 10 minutes on what the institute calls “desktop medicine.” Desktop medicine consists of activities such as communicating with patients through a secure patient portal, responding to patients’ online requests for prescription refills or medical advice, ordering tests, sending staff messages and reviewing test results, says lead researcher and institute associate director Ming Tai-Seale.

“Over time, log records from physicians showed a decline in the time allocated to face-to-face visits, accompanied by an increase in time allocated to desktop medicine,” she says.

Because doctors are spending larger amounts of time dealing administratively with online patient communications and electronic health recording keeping, the Palo Alto study is useful from the perspective that more group practices, hospitals and health systems may need to revise policies, programs and procedures that impact workflow or billing.

For example, most healthcare practices bill private and government health insurers for the volume of patients seen in person, a process known as fee for service. But going forward, payers and providers may need to come up with revised methods of billing and payment that account for a doctor’s time spent dealing with patients online and updating their electronic medical records.

“Staffing and scheduling in the physician’s office, as well as provider payment models for primary care practice, should account for these desktop medicine efforts,” Tai-Seale says.

.