A Time-Motion Study of Primary Care Physicians’ Work in the Electronic Health Record Era

Abstract

BACKGROUND AND OBJECTIVES:Electronic health records (EHRs) have had mixed effects on the workflow of ambulatory primary care. In this study, we update previous research on the time required to care for patients in primary care clinics with EHRs. METHODS:We directly observed family physician (FP) attendings, residents, and their ambulatory patients in 982 visits in clinics affiliated with 10 residencies of the Residency Research Network of Texas. The FPs were purposely chosen to reflect a diversity of patient care styles. We measured total visit time, previsit chart time, face-to-face time, non-face time, out-of-hours EHR work time, and total EHR work time. RESULTS:The mean (SD) visit length was 35.8 (16.6) minutes, not counting resident precepting time. The mean time components included 2.9 (3.8) minutes working in the EHR prior to entering the room, 16.5 (9.2) minutes of faceto-face time not working in the EHR, 2.0 (2.1) minutes working in the EHR in the room (which occurred in 73.4% of the visits), 7.5 (7.5) minutes of non-face time (mostly EHR time), and 6.9 (7.6) minutes of EHR work outside of normal clinic operational hours (which occurred in 64.6% of the visits). The total time and total EHR time varied only slightly between faculty physicians, third-year and second-year residents. Multivariable linear regression analysis revealed many factors associated with total visit time including patient, physician, and clinic infrastructure factors.CONCLUSIONS: Primary care physicians spent more time working in the EHR than they spent in face-to-face time with patients in clinic visits. (Fam Med. 2018;50(2):91-9.)

Coding Family Medicine Residency Clinic Visits, 99213 or 99214? A Residency Research Network of Texas Study

“…A full description of the basic methods has been published previously. 11 Trained observers directly observed family physician-patient encounters and recorded data mostly based on the instruments used by the National Ambulatory Medical Care Survey. These included items such as the number of concerns the patient raised, the number of issues the physician addressed, the number of labs, images, referrals, and prescriptions ordered in the encounter, and the actual CPT code billed by the physician.…”

EHR Overtime: An Analysis of Time Spent After Hours by Family Physicians

“…EHR activity of primary care residents and family medicine faculty have been studied in inpatient and outpatient settings. [8][9][10][11] Methods used to track EHR use include keystrokes and "mouse miles," 8 event logging, direct observation, diaries, and time motion studies. [9][10][11] Studies consistently show marked variation between physicians in EHR time, more time on the computer than in direct patient care, and substantial after-hours EHR use.…”

“…[8][9][10][11] Methods used to track EHR use include keystrokes and "mouse miles," 8 event logging, direct observation, diaries, and time motion studies. [9][10][11] Studies consistently show marked variation between physicians in EHR time, more time on the computer than in direct patient care, and substantial after-hours EHR use. [8][9][10][11] We are not aware of a prior study that has used EHR keystrokes and mouse miles to quantify EHR use in an ambulatory setting in a family medicine residency.…”

Effect of Nonvisit Care on Resident Workload in a Family Medicine Residency

“…Family medicine residents spend nearly the same amount of time on the EHR as face-to-face patient time when including all EHR activities, including documentation and billing. 11 Little information is available on resident work hours dedicated to NVC for work generated in the continuity clinic. In particular, we are not aware of any data estimating the time that FM residents spend on NVC.…”