Notifications Received by Primary Care Practitioners in Electronic Health Records: A Taxonomy and Time Analysis

Murphy, Daniel R.; Reis, Brian; Sittig, Dean F.; Singh, Hardeep

doi:10.1016/j.amjmed.2011.07.029

Cited by 103 publications

(91 citation statements)

References 31 publications

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“…Moreover, the alerts create interruptions known to adversely affect patient care. 12,13 A 2013 survey of 30 physician practices found that electronic health record (EHR) technology has worsened professional satisfaction through time-consuming data entry and interference with patient care. 7 Emergency medicine physicians spend 44% of their day doing data entry, with 4,000 EHR clicks per day; only 28% of the day is spent with patients.…”

Section: Physician Burnoutmentioning

confidence: 99%

From Triple to Quadruple Aim: Care of the Patient Requires Care of the Provider

Bodenheimer

Sinsky

2014

The Annals of Family Medicine

2,486

1,733

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The Triple Aim-enhancing patient experience, improving population health, and reducing costs-is widely accepted as a compass to optimize health system performance. Yet physicians and other members of the health care workforce report widespread burnout and dissatisfaction. Burnout is associated with lower patient satisfaction, reduced health outcomes, and it may increase costs. Burnout thus imperils the Triple Aim. This article recommends that the Triple Aim be expanded to a Quadruple Aim, adding the goal of improving the work life of health care providers, including clinicians and staff. INTRODUCTION Since Don Berwick and colleagues introduced the Triple Aim into the health care lexicon, this concept has spread to all corners of the health care system. The Triple Aim is an approach to optimizing health system performance, proposing that health care institutions simultaneously pursue 3 dimensions of performance: improving the health of populations, enhancing the patient experience of care, and reducing the per capita cost of health care.1 The primary Triple Aim goal is to improve the health of the population, with 2 secondary goals-improving patient experience and reducing costs-contributing to the achievement of the primary goal.In visiting primary care practices around the country, 2 the authors have repeatedly heard statements such as, "We have adopted the Triple Aim as our framework, but the stressful work life of our clinicians and staff impacts our ability to achieve the 3 aims." These sentiments made us wonder, might there be a fourth aim-improving the work life of health care clinicians and staff-that, like the patient experience and cost reduction aims, must be achieved in order to succeed in improving population health? Should the Triple Aim become the Quadruple Aim? RISING EXPECTATIONS OF PHYSICIANS AND PRACTICESSociety expects more and more of physicians and practices, particularly in primary care. Patients want their health to be better, to be seen in a timely fashion with empathy, and to enjoy a continuous relationship with a high-quality clinician whom they choose.3 A patient-centered practice has been described as, "They give me exactly the help I need and want exactly when I need and want it."4 Yet for primary care, society has not provided the resources to meet these lofty benchmarks. PHYSICIAN BURNOUTThe wide gap between societal expectations and professional reality has set the stage for 46% of US physicians to experience symptoms of Professional burnout is characterized by loss of enthusiasm for work, feelings of cynicism, and a low sense of personal accomplishment and is associated with early retirement, alcohol use, and suicidal ideation. 5,7 According to a recent RAND Corporation survey, the principal driver of physician satisfaction is the ability to provide quality care.7 Physician dissatisfaction, therefore, is an early warning sign of a health care system creating barriers to high-quality practice.We have heard physicians making such statements as:"The joy of practicing medici...

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Section: Physician Burnoutmentioning

confidence: 99%

From Triple to Quadruple Aim: Care of the Patient Requires Care of the Provider

Bodenheimer

Sinsky

2014

The Annals of Family Medicine

2,486

1,733

View full text Add to dashboard Cite

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“…[1][2][3] Remote availability of the EHR means practicing physicians and trainees may complete chart documentation outside of work and after usual working hours. The Accreditation Council for Graduate Medical Education (ACGME) expects residency program directors to monitor their work hours, including the time residents spend documenting patient care after hours.…”

Section: Introductionmentioning

confidence: 99%

Resident Duty Hours in the Outpatient Electronic Health Record Era: Inaccuracies and Implications

Gilleland¹,

Komis²,

Chawla³

et al. 2014

Journal of Graduate Medical Education

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Background The Accreditation Council for Graduate Medical Education expects resident duty hours to be monitored, yet no previous studies have examined the effect of after-hours electronic health record (EHR) use on resident hours or burnout. Objective We assessed internal medicine residents' perceived and actual time spent on after-hours outpatient EHR use and calculated increased duty hours if after-hours EHR use were included; we also assessed its effect on resident burnout. Methods We retrospectively aggregated time spent logged on to the outpatient EHR for residents in a general internal medicine clinic for 13 weeks in 2011. Residents completed a survey on EHR use, which was correlated with objectively recorded data on EHR usage. We compared actual and self-reported EHR time and identified violations that would be generated if these hours were included in reported duty hours. We also correlated resident after-hours EHR use with responses to an internally developed burnout survey. Results The 44 residents in this study overestimated time spent on the ambulatory EHR (they spent 3.03 hours/week on after-hours use compared with a recorded 1.20 hours/week). In total, 190 duty hour violations (mean duration of violation = 37 minutes) would have been generated if after-hours EHR usage were included in residents' reported duty hours. Conclusions Resident estimates of EHR use by residents were not accurate; including after-hours EHR use would increase the number of reported duty hour violations. There was no association between after-hours EHR use and resident burnout.

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“…14,15 Cognitive limitations of providers also contribute to delays in followup: for example, providers are often unable to discern relevant versus irrelevant information when assessing the need for follow-up while also dealing with information overload and alert fatigue. 16,17 Given these and other vulnerabilities in outpatient care, Bback-up^surveillance systems are needed to help ensure that follow-up actions proceed as intended.…”

Section: Introductionmentioning

confidence: 99%

Electronic Detection of Delayed Test Result Follow-Up in Patients with Hypothyroidism

et al. 2017

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BACKGROUND: Delays in following up abnormal test results are a common problem in outpatient settings. Surveillance systems that use trigger tools to identify delayed follow-up can help reduce missed opportunities in care. OBJECTIVE: To develop and test an electronic health record (EHR)-based trigger algorithm to identify instances of delayed follow-up of abnormal thyroid-stimulating hormone (TSH) results in patients being treated for hypothyroidism. DESIGN: We developed an algorithm using structured EHR data to identify patients with hypothyroidism who had delayed follow-up (>60 days) after an abnormal TSH. We then retrospectively applied the algorithm to a large EHR data warehouse within the Department of Veterans Affairs (VA), on patient records from two large VA networks for the period from January 1, 2011, to December 31, 2011. Identified records were reviewed to confirm the presence of delays in follow-up. KEY RESULTS: During the study period, 645,555 patients were seen in the outpatient setting within the two networks. Of 293,554 patients with at least one TSH test result, the trigger identified 1250 patients on treatment for hypothyroidism with elevated TSH. Of these patients, 271 were flagged as potentially having delayed follow-up of their test result. Chart reviews confirmed delays in 163 of the 271 flagged patients (PPV = 60.1%). CONCLUSIONS: An automated trigger algorithm applied to records in a large EHR data warehouse identified patients with hypothyroidism with potential delays in thyroid function test results follow-up. Future prospective application of the TSH trigger algorithm can be used by clinical teams as a surveillance and quality improvement technique to monitor and improve follow-up.

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Notifications Received by Primary Care Practitioners in Electronic Health Records: A Taxonomy and Time Analysis

Cited by 103 publications

References 31 publications

From Triple to Quadruple Aim: Care of the Patient Requires Care of the Provider

From Triple to Quadruple Aim: Care of the Patient Requires Care of the Provider

Resident Duty Hours in the Outpatient Electronic Health Record Era: Inaccuracies and Implications

Electronic Detection of Delayed Test Result Follow-Up in Patients with Hypothyroidism

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