Use of Internist's Free Time by Ambulatory Care Electronic Medical Record Systems

McDonald, Clement J.; Callaghan, Fiona; Weissman, Arlene; Goodwin, Rebecca; Mundkur, Mallika; Kuhn, Thomson

doi:10.1001/jamainternmed.2014.4506

Cited by 66 publications

(43 citation statements)

References 4 publications

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“…Even when data are appropriately stored, it can be timeconsuming to manually search multiple sections of the EHR to obtain necessary CKD-related data during a patient visit (34). EHRs could offer provider-facing flow sheets to display all important CKD-related data in one location.…”

Section: Ckd-related Data In Ehrs Should Be Readily Available and Easmentioning

confidence: 99%

CKD as a Model for Improving Chronic Disease Care through Electronic Health Records

Drawz

Archdeacon

McDonald

et al. 2015

Clinical Journal of the American Society of Nephrology

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Electronic health records have the potential to improve the care of patients with chronic medical conditions. CKD provides a unique opportunity to show this potential: the disease is common in the United States, there is significant room to improve CKD detection and management, CKD and its related conditions are defined primarily by objective laboratory data, CKD care requires collaboration by a diverse team of health care professionals, and improved access to CKD-related data would enable identification of a group of patients at high risk for multiple adverse outcomes. However, to realize the potential for improvement in CKD-related care, electronic health records will need to provide optimal functionality for providers and patients and interoperability across multiple health care settings. The goal of the National Kidney Disease Education Program Health Information Technology Working Group is to enable and support the widespread interoperability of data related to kidney health among health care software applications to optimize CKD detection and management. Over the course of the last 2 years, group members met to identify general strategies for using electronic health records to improve care for patients with CKD. This paper discusses these strategies and provides general goals for appropriate incorporation of CKD-related data into electronic health records and corresponding design features that may facilitate (1) optimal care of individual patients with CKD through improved access to clinical information and decision support, (2) clinical quality improvement through enhanced population management capabilities, (3) CKD surveillance to improve public health through wider availability of population-level CKD data, and (4) research to improve CKD management practices through efficiencies in study recruitment and data collection. Although these strategies may be most effectively applied in the setting of CKD, because it is primarily defined by laboratory abnormalities and therefore, an ideal computable electronic health record phenotype, they may also apply to other chronic diseases.

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Section: Ckd-related Data In Ehrs Should Be Readily Available and Easmentioning

confidence: 99%

CKD as a Model for Improving Chronic Disease Care through Electronic Health Records

Drawz

Archdeacon

McDonald

et al. 2015

Clinical Journal of the American Society of Nephrology

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“…[2][3][4][5][6] Factors such as increased structured documentation requirements, computerized physician order entry (CPOE), inbox management, patient portals, and a redistribution of tasks previously performed by clinical staff to clinicians has led to more work that is not direct face time with patients. [7][8][9][10][11] A 2016 study showed physicians from family medicine, internal medicine, cardiology, and orthopedics spent nearly 2 hours in the EHR and on other desk work for every 1 hour of direct patient care. 7 In our own primary care system during 2013-2016, despite a stable 2.2 average office visits per panel member per year, telephone calls increased by 3% and MyChart portal encounters increased by 62% to an average of 0.66 per panel member per year.…”

Section: Introductionmentioning

confidence: 99%

Tethered to the EHR: Primary Care Physician Workload Assessment Using EHR Event Log Data and Time-Motion Observations

Beasley²,

et al. 2017

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PURPOSE Primary care physicians spend nearly 2 hours on electronic health record (EHR) tasks per hour of direct patient care. Demand for non-face-to-face care, such as communication through a patient portal and administrative tasks, is increasing and contributing to burnout. The goal of this study was to assess time allocated by primary care physicians within the EHR as indicated by EHR userevent log data, both during clinic hours (defined as 8:00 am to 6:00 pm Monday through Friday) and outside clinic hours. METHODSWe conducted a retrospective cohort study of 142 family medicine physicians in a single system in southern Wisconsin. All Epic (Epic Systems Corporation) EHR interactions were captured from "event logging" records over a 3-year period for both direct patient care and non-face-to-face activities, and were validated by direct observation. EHR events were assigned to 1 of 15 EHR task categories and allocated to either during or after clinic hours.RESULTS Clinicians spent 355 minutes (5.9 hours) of an 11.4-hour workday in the EHR per weekday per 1.0 clinical full-time equivalent: 269 minutes (4.5 hours) during clinic hours and 86 minutes (1.4 hours) after clinic hours. Clerical and administrative tasks including documentation, order entry, billing and coding, and system security accounted for nearly one-half of the total EHR time (157 minutes, 44.2%). Inbox management accounted for another 85 minutes (23.7%).CONCLUSIONS Primary care physicians spend more than one-half of their workday, nearly 6 hours, interacting with the EHR during and after clinic hours. EHR event logs can identify areas of EHR-related work that could be delegated, thus reducing workload, improving professional satisfaction, and decreasing burnout. Direct time-motion observations validated EHR-event log data as a reliable source of information regarding clinician time allocation. Ann Fam Med 2017;15:419-426. https://doi.org/10.1370/afm.2121. INTRODUCTIONP rimary care has become increasingly complex, 1 with electronic health record (EHR) systems adding to the complexity. Our patients expect same-day access for face-to-face care during clinic hours and rapid responses to telephone calls, patient portal messages, laboratory result inquiries, and prescription renewal requests both during and after clinic hours. This concurrent face-to-face (synchronous) and non-faceto-face (asynchronous) care, combined with administrative and regulatory work (prior authorizations, billing and coding, performance measurement) results in considerable strain on the primary care team. It is imperative to understand factors contributing to workload and identify practical solutions to these challenges.US physicians spend numerous hours daily interacting with EHR systems, contributing to work-life imbalance, dissatisfaction, high rates of attrition, and a burnout rate exceeding 50%. entry (CPOE), inbox management, patient portals, and a redistribution of tasks previously performed by clinical staff to clinicians has led to more work that is not direct fac...

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“…1 Reviews of the effect of EHRs on patient and physician outcomes have been mixed, including neutral to small positive effects on common quality metrics and disease-specific guidelines, 2-5 mixed on office workflow, 2,6,7 and mostly decreased on primary care physician productivity. [8][9][10] There is little to no evidence that patient outcomes are improved or overall health care costs are reduced.…”

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confidence: 99%

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

Young¹,

Burge

Kumar

et al. 2018

Fam Med

134

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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.)

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Use of Internist's Free Time by Ambulatory Care Electronic Medical Record Systems

Cited by 66 publications

References 4 publications

CKD as a Model for Improving Chronic Disease Care through Electronic Health Records

CKD as a Model for Improving Chronic Disease Care through Electronic Health Records

Tethered to the EHR: Primary Care Physician Workload Assessment Using EHR Event Log Data and Time-Motion Observations

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

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