Leveraging Electronic Health Records to Develop Measurements for Processes of Care

Tai-Seale, Ming; Wilson, Caroline; Panattoni, Laura; Kohli, Nidhi; Stone, Ashley; Hung, Dorothy; Chung, Sukyung

doi:10.1111/1475-6773.12126

Cited by 18 publications

(16 citation statements)

References 20 publications

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“…Studies have used EHR data to identify care processes within and across providers in closed delivery systems and regional health information exchanges. 81,82 Once more clinically meaningful data (e.g., on referrals, condition management over time, and comorbidities) become routinely collected, standardized and aggregated across providers, EHR data could help to determine which providers are the most comprehensive. In the meantime, the respective strengths, weaknesses and validity of both claims-based and e-measures of comprehensiveness should continue to be assessed.…”

Section: How Do We Validate a Measure When There Is No Goldmentioning

confidence: 99%

Measuring Comprehensiveness of Primary Care: Challenges and Opportunities

O’Malley

Rich

2015

J GEN INTERN MED

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Section: How Do We Validate a Measure When There Is No Goldmentioning

confidence: 99%

Measuring Comprehensiveness of Primary Care: Challenges and Opportunities

O’Malley

Rich

2015

J GEN INTERN MED

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“…), how to leverage electronic health records systems to measure and track key processes of care outcomes (Tai‐Seale et al. ), and how to keep patients at the center of practice redesign (Berenson et al. ).…”

Section: Practice Relationshipsmentioning

confidence: 99%

Trust and Reflection in Primary Care Practice Redesign

Lanham

Palmer

Leykum

et al. 2015

Health Services Research

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“…23 The clinic's adoption of patientcentered practices was measured by recognition by the National Committee on Quality Assurance (NCQA), with level 3 being the highest level of recognition and level 1 the lowest. 24 Data management was completed in SAS, version 5.1. Analyses were conducted in both SAS Enterprise Guide, version 5.1, and Stata, version 13.1.…”

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confidence: 99%

Electronic Health Record Logs Indicate That Physicians Split Time Evenly Between Seeing Patients And Desktop Medicine

Tai-Seale¹,

et al. 2017

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Time spent by physicians is a key resource in health care delivery. This study used data captured by the access time stamp functionality of an electronic health record (EHR) to examine physician work effort. This is a potentially powerful, yet unobtrusive, way to study physicians' use of time. We used data on physicians' time allocation patterns captured by over thirty-one million EHR transactions in the period 2011-14 recorded by 471 primary care physicians, who collectively worked on 765,129 patients' EHRs. Our results suggest that the physicians logged an average of 3.08 hours on office visits and 3.17 hours on desktop medicine each day. 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. 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 HHS Public AccessAuthor manuscript Health Aff (Millwood). Author manuscript; available in PMC 2017 August 07. Author Manuscript Author ManuscriptAuthor Manuscript Author Manuscript to desktop medicine. 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.Physician time is a key resource in health services delivery. Understanding how physicians spend their clinical time is essential, given the need to understand practical capacity; guide staffing, scheduling, and support models in the physician's office; and improve the accuracy of payment for physician services. Fee-for-service payments are intended to reflect resources (captured as relative value units, or RVUs) used before, during, and after clinical encounters associated with face-to-face ambulatory care visits. 1-3 Questions have been raised about whether the reports underlying the RVU estimates are accurate and representative of true physician effort in providing patient care services. In the age of electronic health records (EHRs) with patient portals, patients often request services (such as prescription refills and medical advice) online, without face-to-face visits. Physician effort in addressing these online requests was absent from the original RVU calculations. [1][2][3] In addition to physician reports of their own efforts, 2,4,5 researchers have used time-andmotion studies 6 and video 7 and audio recordings. 8 While these methods capture significant physician effort, 6,9-11 they are costly to use and often evaluate only a limited number of physicians. Even the resource-based relative values scale (RBRVS) was built, for some specialties, on survey responses to vignettes from about twenty physicians. 1 This scale is still the chief tool used to determine the periodic updates to the Medicare Fee Schedule. Furthermore, concerns about the Hawthorne effect preclude ongoing, broad-based direct observa...

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Leveraging Electronic Health Records to Develop Measurements for Processes of Care

Abstract: The EHR offers process of care measures which can augment patient-reported measures of patient-centeredness. Two of them are significantly associated with clinical outcomes. Future research should examine their association with additional outcomes.

Cited by 18 publications

References 20 publications

Measuring Comprehensiveness of Primary Care: Challenges and Opportunities

Measuring Comprehensiveness of Primary Care: Challenges and Opportunities

Trust and Reflection in Primary Care Practice Redesign

Electronic Health Record Logs Indicate That Physicians Split Time Evenly Between Seeing Patients And Desktop Medicine

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