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

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 as...

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Vydané v:	Annals of family medicine Ročník 15; číslo 5; s. 419
Hlavní autori:	Arndt, Brian G, Beasley, John W, Watkinson, Michelle D, Temte, Jonathan L, Tuan, Wen-Jan, Sinsky, Christine A, Gilchrist, Valerie J
Médium:	Journal Article
Jazyk:	English
Vydavateľské údaje:	United States 01.09.2017
Predmet:	Adult Burnout, Professional - etiology Electronic Health Records - statistics & numerical data Female Humans Male Middle Aged Physicians, Primary Care - psychology Physicians, Primary Care - statistics & numerical data Primary Health Care - methods Retrospective Studies Time and Motion Studies Workload - psychology Workload - statistics & numerical data primary care workload electronic health records health information technology burnout practice-based research
ISSN:	1544-1717, 1544-1717
On-line prístup:	Zistit podrobnosti o prístupe
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Abstract	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 user-event log data, both during clinic hours (defined as 8:00 am to 6:00 pm Monday through Friday) and outside clinic hours. We 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. 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%). 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.
AbstractList	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 user-event log data, both during clinic hours (defined as 8:00 am to 6:00 pm Monday through Friday) and outside clinic hours. We 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. 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%). 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. 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 user-event log data, both during clinic hours (defined as 8:00 am to 6:00 pm Monday through Friday) and outside clinic hours.PURPOSEPrimary 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 user-event log data, both during clinic hours (defined as 8:00 am to 6:00 pm Monday through Friday) and outside clinic hours.We 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.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.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%).RESULTSClinicians 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%).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.CONCLUSIONSPrimary 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.
Author	Beasley, John W Gilchrist, Valerie J Arndt, Brian G Tuan, Wen-Jan Temte, Jonathan L Watkinson, Michelle D Sinsky, Christine A
Author_xml	– sequence: 1 givenname: Brian G surname: Arndt fullname: Arndt, Brian G email: brian.arndt@fammed.wisc.edu organization: School of Medicine and Public Health, Department of Family Medicine and Community Health, University of Wisconsin, Madison, Wisconsin brian.arndt@fammed.wisc.edu – sequence: 2 givenname: John W surname: Beasley fullname: Beasley, John W organization: University of Wisconsin College of Engineering, Department of Industrial and Systems Engineering, Madison, Wisconsin – sequence: 3 givenname: Michelle D surname: Watkinson fullname: Watkinson, Michelle D organization: School of Medicine and Public Health, Department of Family Medicine and Community Health, University of Wisconsin, Madison, Wisconsin – sequence: 4 givenname: Jonathan L surname: Temte fullname: Temte, Jonathan L organization: School of Medicine and Public Health, Department of Family Medicine and Community Health, University of Wisconsin, Madison, Wisconsin – sequence: 5 givenname: Wen-Jan surname: Tuan fullname: Tuan, Wen-Jan organization: School of Medicine and Public Health, Department of Family Medicine and Community Health, University of Wisconsin, Madison, Wisconsin – sequence: 6 givenname: Christine A surname: Sinsky fullname: Sinsky, Christine A organization: American Medical Association, Chicago, Illinois – sequence: 7 givenname: Valerie J surname: Gilchrist fullname: Gilchrist, Valerie J organization: School of Medicine and Public Health, Department of Family Medicine and Community Health, University of Wisconsin, Madison, Wisconsin
BackLink	https://www.ncbi.nlm.nih.gov/pubmed/28893811$$D View this record in MEDLINE/PubMed
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References	24005796 - J Am Med Inform Assoc. 2014 Feb;21(e1):e100-6 28196201 - JAMA. 2017 Mar 7;317(9):901-902 23690328 - Ann Fam Med. 2013 May-Jun;11(3):272-8 26436181 - WMJ. 2015 Aug;114(4):135-42 24380671 - Int J Med Inform. 2014 Mar;83(3):225-34 18830762 - J Gen Intern Med. 2008 Dec;23(12):2058-65 22332168 - Arch Intern Med. 2012 Feb 13;172(3):285-7 24247673 - Ann Intern Med. 2013 Nov 19;159(10):677-87 24002633 - J Gen Intern Med. 2014 Jan;29(1):18-20 18373144 - J Gen Intern Med. 2008 Apr;23(4):451-8 22911330 - Arch Intern Med. 2012 Oct 8;172(18):1377-85 25200944 - JAMA Intern Med. 2014 Nov;174(11):1860-3 26335987 - J Am Med Inform Assoc. 2016 Jan;23 (1):29-37 25384822 - Ann Fam Med. 2014 Nov-Dec;12(6):573-6 22269625 - Am J Med. 2012 Feb;125(2):209.e1-7 27595430 - Ann Intern Med. 2016 Dec 6;165(11):753-760 25755035 - Ann Fam Med. 2015 Mar;13(2):139-48 26653297 - Mayo Clin Proc. 2015 Dec;90(12):1600-13 27613794 - J Am Board Fam Med. 2016 Sep-Oct;29(5):613-9 27313121 - Mayo Clin Proc. 2016 Jul;91(7):836-48 28083306 - Rand Health Q. 2014 Dec 1;3(4):1 24835678 - J Eval Clin Pract. 2014 Dec;20(6):896-901
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Snippet	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...
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SubjectTerms	Adult Burnout, Professional - etiology Electronic Health Records - statistics & numerical data Female Humans Male Middle Aged Physicians, Primary Care - psychology Physicians, Primary Care - statistics & numerical data Primary Health Care - methods Retrospective Studies Time and Motion Studies Workload - psychology Workload - statistics & numerical data
Title	Tethered to the EHR: Primary Care Physician Workload Assessment Using EHR Event Log Data and Time-Motion Observations
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