Workflow and electronic health records in small medical practices

Abstract

This study analyzes the workflow and implementation of Electronic Health Record (EHR) systems across different functions in small physician offices. We characterize the differences in the offices with different levels of computerization in terms of workflow, sources of time delay, and barriers to the support of the entire workflow through the use of EHR systems. Design: The study was based on a combination of questionnaires, interviews, in situ observations and data collection efforts. The study was performed at 13 small practice physician offices in the Baltimore and New York areas. The offices included both primary care providers (4) and specialty providers (9). A total of 50 person-hours were spent with the staff to observe and capture the present work practice. This study was not intended to be a full-scale time-and-motion study with precise measurements, but to provide an overview of the potential sources of delays while performing office tasks. Method: This study follows an interpretive model of case studies rather than a large sample statistical survey of practices. Workflow maps were created based on the aggregated data from the offices to identify time-consuming tasks. This information was used to compare and contrast the workflow maps for offices with and without EHR implementation. The workflow maps for specialist and primary care physicians were studied to understand the differences in workflow complexity that may be a factor in the differential adoption of EHR systems by the two types of offices. Results: The results from the study show that specialty physicians are more favorable towards adopting EHR systems than primary care physicians. The results further indicate that while primary care physicians favored introducing EHR systems in their offices, the barriers to do so were greater than those encountered by specialists. This can be attributed to the complex workflows that exist in the primary care physician offices, leading to non-standardized workflow structures and practices. The results suggest that primary care physicians would benefit more from EHR systems if they could interact with external entities through computer-based transactions. Presently, non-standard ways of interaction with external entities and inadequate computerization are the primary barriers to moving away from paper-based systems. Without being able to move away from a paper-based system, an EHR system becomes an extra burden and results in low rates of adoption. Conclusions: Significant variations were observed in workflow characteristics between primary care and specialty physicians that could be attributed to the variety and multiplicity of external interactions. It is easier to adopt an off-the shelf system if the variety and number of interactions are constrained. The manual nature of the tasks in non-EHR-based offices results in considerable waste of time and increase in cost. Any move to an EHR system should hence include a strategy for communicating with the outside world.

Disparities in Primary Care EHR Adoption Rates

“…Ramaiah et al found that primary care physicians, who are disproportionately represented in small practices, tended to have more complex workflows and were less likely to have adopted EHRs compared to specialty physicians. 10 …”

Differing Strategies to Meet Information-Sharing Needs: Publicly Supported Community Health Information Exchanges Versus Health Systems’ Enterprise Health Information Exchanges

“…As our interviewees pointed out, the richness of clinical data and the integration of features may be unmatched by any community HIE or other mechanism to exchange information. Ultimately, once connected to an enterprise HIE, it could be simply easier and cheaper for ambulatory care providers to refer patients to only those other connected institutions . This expectation has precedents.…”

A Comparison of Usability Factors of Four Mobile Devices for Accessing Healthcare Information by Adolescents

“…Participants also chose incorrect icons or links when they were too close together on the screen or too small to differentiate. As a result, future design of mobile technology should focus on the time needed to effectively use the device since a motivated user will complete the task but is less likely to want to adopt a technology which takes too much of their time [21, 22]. …”