scholarly journals Physicians’ electronic inbox work patterns and factors associated with high inbox work duration

2020 ◽  
Author(s):  
Fatema Akbar ◽  
Gloria Mark ◽  
E Margaret Warton ◽  
Mary E Reed ◽  
Stephanie Prausnitz ◽  
...  
Keyword(s):  
Primary Care Physicians ◽  
Older Patients ◽  
Demographic Data ◽  
Work Hours ◽  
Health Record ◽  
Work Patterns ◽  
Work Time ◽  
Factors Associated ◽  
Use Patterns ◽  
Work Duration

Abstract Objectives Electronic health record systems are increasingly used to send messages to physicians, but research on physicians’ inbox use patterns is limited. This study’s aims were to (1) quantify the time primary care physicians (PCPs) spend managing inboxes; (2) describe daily patterns of inbox use; (3) investigate which types of messages consume the most time; and (4) identify factors associated with inbox work duration. Materials and Methods We analyzed 1 month of electronic inbox data for 1275 PCPs in a large medical group and linked these data with physicians’ demographic data. Results PCPs spent an average of 52 minutes on inbox management on workdays, including 19 minutes (37%) outside work hours. Temporal patterns of electronic inbox use differed from other EHR functions such as charting. Patient-initiated messages (28%) and results (29%) accounted for the most inbox work time. PCPs with higher inbox work duration were more likely to be female (P < .001), have more patient encounters (P < .001), have older patients (P < .001), spend proportionally more time on patient messages (P < .001), and spend more time per message (P < .001). Compared with PCPs with the lowest duration of time on inbox work, PCPs with the highest duration had more message views per workday (200 vs 109; P < .001) and spent more time on the inbox outside work hours (30 minutes vs 9.7 minutes; P < .001). Conclusions Electronic inbox work by PCPs requires roughly an hour per workday, much of which occurs outside scheduled work hours. Interventions to assist PCPs in handling patient-initiated messages and results may help alleviate inbox workload.

scholarly journals Physician Stress During Electronic Health Record Inbox Work: In Situ Measurement With Wearable Sensors (Preprint)

2020 ◽  
Author(s):  
Fatema Akbar ◽  
Gloria Mark ◽  
Stephanie Prausnitz ◽  
E Margaret Warton ◽  
Jeffrey A East ◽  
...  
Keyword(s):  
Heart Rate ◽  
Electronic Health Record ◽  
Physiological Stress ◽  
Work Hours ◽  
Health Record ◽  
Work Patterns ◽  
Work Duration ◽  
Electronic Health ◽  
Physician Stress ◽  
Stress Patterns

BACKGROUND Increased work through electronic health record (EHR) messaging is frequently cited as a factor of physician burnout. However, studies to date have relied on anecdotal or self-reported measures, which limit the ability to match EHR use patterns with continuous stress patterns throughout the day. OBJECTIVE The aim of this study is to collect EHR use and physiologic stress data through unobtrusive means that provide objective and continuous measures, cluster distinct patterns of EHR inbox work, identify physicians’ daily physiologic stress patterns, and evaluate the association between EHR inbox work patterns and physician physiologic stress. METHODS Physicians were recruited from 5 medical centers. Participants (N=47) were given wrist-worn devices (Garmin Vivosmart 3) with heart rate sensors to wear for 7 days. The devices measured physiological stress throughout the day based on heart rate variability (HRV). Perceived stress was also measured with self-reports through experience sampling and a one-time survey. From the EHR system logs, the time attributed to different activities was quantified. By using a clustering algorithm, distinct inbox work patterns were identified and their associated stress measures were compared. The effects of EHR use on physician stress were examined using a generalized linear mixed effects model. RESULTS Physicians spent an average of 1.08 hours doing EHR inbox work out of an average total EHR time of 3.5 hours. Patient messages accounted for most of the inbox work time (mean 37%, SD 11%). A total of 3 patterns of inbox work emerged: inbox work mostly outside work hours, inbox work mostly during work hours, and inbox work extending after hours that were mostly contiguous to work hours. Across these 3 groups, physiologic stress patterns showed 3 periods in which stress increased: in the first hour of work, early in the afternoon, and in the evening. Physicians in group 1 had the longest average stress duration during work hours (80 out of 243 min of valid HRV data; <i>P</i>=.02), as measured by physiological sensors. Inbox work duration, the rate of EHR window switching (moving from one screen to another), the proportion of inbox work done outside of work hours, inbox work batching, and the day of the week were each independently associated with daily stress duration (marginal <i>R<sup>2</sup></i>=15%). Individual-level random effects were significant and explained most of the variation in stress (conditional <i>R<sup>2</sup></i>=98%). CONCLUSIONS This study is among the first to demonstrate associations between electronic inbox work and physiological stress. We identified 3 potentially modifiable factors associated with stress: EHR window switching, inbox work duration, and inbox work outside work hours. Organizations seeking to reduce physician stress may consider system-based changes to reduce EHR window switching or inbox work duration or the incorporation of inbox management time into work hours. CLINICALTRIAL

scholarly journals Physician Stress During Electronic Health Record Inbox Work: In Situ Measurement With Wearable Sensors

10.2196/24014 ◽  
2021 ◽  
Vol 9 (4) ◽  
pp. e24014
Author(s):  
Fatema Akbar ◽  
Gloria Mark ◽  
Stephanie Prausnitz ◽  
E Margaret Warton ◽  
Jeffrey A East ◽  
...  
Keyword(s):  
Heart Rate ◽  
Electronic Health Record ◽  
Physiological Stress ◽  
Work Hours ◽  
Health Record ◽  
Work Patterns ◽  
Work Duration ◽  
Electronic Health ◽  
Physician Stress ◽  
Stress Patterns

Background Increased work through electronic health record (EHR) messaging is frequently cited as a factor of physician burnout. However, studies to date have relied on anecdotal or self-reported measures, which limit the ability to match EHR use patterns with continuous stress patterns throughout the day. Objective The aim of this study is to collect EHR use and physiologic stress data through unobtrusive means that provide objective and continuous measures, cluster distinct patterns of EHR inbox work, identify physicians’ daily physiologic stress patterns, and evaluate the association between EHR inbox work patterns and physician physiologic stress. Methods Physicians were recruited from 5 medical centers. Participants (N=47) were given wrist-worn devices (Garmin Vivosmart 3) with heart rate sensors to wear for 7 days. The devices measured physiological stress throughout the day based on heart rate variability (HRV). Perceived stress was also measured with self-reports through experience sampling and a one-time survey. From the EHR system logs, the time attributed to different activities was quantified. By using a clustering algorithm, distinct inbox work patterns were identified and their associated stress measures were compared. The effects of EHR use on physician stress were examined using a generalized linear mixed effects model. Results Physicians spent an average of 1.08 hours doing EHR inbox work out of an average total EHR time of 3.5 hours. Patient messages accounted for most of the inbox work time (mean 37%, SD 11%). A total of 3 patterns of inbox work emerged: inbox work mostly outside work hours, inbox work mostly during work hours, and inbox work extending after hours that were mostly contiguous to work hours. Across these 3 groups, physiologic stress patterns showed 3 periods in which stress increased: in the first hour of work, early in the afternoon, and in the evening. Physicians in group 1 had the longest average stress duration during work hours (80 out of 243 min of valid HRV data; P=.02), as measured by physiological sensors. Inbox work duration, the rate of EHR window switching (moving from one screen to another), the proportion of inbox work done outside of work hours, inbox work batching, and the day of the week were each independently associated with daily stress duration (marginal R2=15%). Individual-level random effects were significant and explained most of the variation in stress (conditional R2=98%). Conclusions This study is among the first to demonstrate associations between electronic inbox work and physiological stress. We identified 3 potentially modifiable factors associated with stress: EHR window switching, inbox work duration, and inbox work outside work hours. Organizations seeking to reduce physician stress may consider system-based changes to reduce EHR window switching or inbox work duration or the incorporation of inbox management time into work hours.

scholarly journals Factors Associated With Primary Care Physicians’ Recognition of Cognitive Impairment in Their Older Patients

2014 ◽  
Vol 28 (4) ◽  
pp. 320-325 ◽  
Author(s):  
Mary C. Tierney ◽  
Gary Naglie ◽  
Ross Upshur ◽  
Liisa Jaakkimainen ◽  
Rahim Moineddin ◽  
...  
Keyword(s):  
Primary Care ◽  
Cognitive Impairment ◽  
Primary Care Physicians ◽  
Older Patients ◽  
Factors Associated

scholarly journals Factors Associated With Adoption of the Electronic Health Record System Among Primary Care Physicians

2013 ◽  
Vol 1 (1) ◽  
pp. e1 ◽  
Author(s):  
Clement SK Cheung ◽  
Ellen LH Tong ◽  
Ngai Tseung Cheung ◽  
Wai Man Chan ◽  
Harry HX Wang ◽  
...  
Keyword(s):  
Primary Care ◽  
Electronic Health Record ◽  
Primary Care Physicians ◽  
Electronic Health Record System ◽  
Health Record ◽  
Record System ◽  
Factors Associated ◽  
Electronic Health

scholarly journals Do electronic reminders alter recorded diagnoses in primary care office-hours practices of health centers: A register-based study in a Finnish city

2021 ◽  
Vol 9 ◽  
pp. 205031212110361
Author(s):  
Mika Lehto ◽  
Kaisu Pitkälä ◽  
Ossi Rahkonen ◽  
Merja K Laine ◽  
Marko Raina ◽  
...  
Keyword(s):  
Primary Care ◽  
Primary Care Physicians ◽  
Health Centers ◽  
Health Record ◽  
Record System ◽  
Electronic Reminder ◽  
Primary Health ◽  
Primary Care Health ◽  
Before And After ◽  
Care Health

Objectives: One purpose of electronic reminders is improvement of the quality of documentation in office-hours primary care. The aim of this study was to evaluate how implementation of electronic reminders alters the rate and/or content of diagnostic data recorded by primary care physicians in office-hours practices in primary care health centers. Methods: The present work is a register-based longitudinal follow-up study with a before-and-after design. An electronic reminder was installed in the electronic health record system of the primary health care of a Finnish city to remind physicians to include the diagnosis code of the visit in the health record. The report generator of the electronic health record system provided monthly figures for the number of various recorded diagnoses by using the International Classification of Diseases, 10th edition, and the total number of visits to primary care physicians, thus allowing the calculation of the recording rate of diagnoses on a monthly basis. The distribution of diagnoses before and after implementing ERs was also compared. Results: After the introduction of the electronic reminder, the rate of diagnosis recording by primary care physicians increased clearly from 39.7% to 87.2% (p < 0.001). The intervention enhanced the recording rate of symptomatic diagnoses (group R) and some chronic diseases such as hypertension, type 2 diabetes and other soft tissue disorders. Recording rate of diagnoses related to diseases of the respiratory system (group J), injuries, poisoning and certain other consequences of external causes (group S), and diseases of single body region of the musculoskeletal system and connective tissue (group M) decreased after the implementation of electronic reminders. Conclusion: Electronic reminders may alter the contents and extent of recorded diagnosis data in office-hours practices of the primary care health centers. They were found to have an influence on the recording rates of diagnoses related to chronic diseases. Electronic reminders may be a useful tool in primary health care when attempting to change the behavior of primary care physicians.

scholarly journals Factors Associated with Extraction following Root Canal Filling in Adults

2021 ◽  
pp. 002203452098296
Author(s):  
H. Fransson ◽  
L. Bjørndal ◽  
F. Frisk ◽  
V.S. Dawson ◽  
K. Landt ◽  
...  
Keyword(s):  
Regression Analysis ◽  
Educational Level ◽  
Demographic Data ◽  
Adult Population ◽  
Disposable Income ◽  
Country Of Birth ◽  
Odds Ratios ◽  
Root Canal Filling ◽  
Factors Associated ◽  
Direct Restoration

Essentially, root fillings are performed to preserve natural teeth. Over time, however, some root-filled teeth will inevitably be extracted. The aim of this historical prospective cohort study in the adult Swedish population was to identify factors associated with extractions within 5 y of registration of a root filling. The cohort consisted of all those whose root fillings had been reported to the tax-funded Swedish Social Insurance Agency (SSIA) in 2009. Demographic data on the individuals registered with a root filling (sex, age, country of birth, disposable income, educational level, and marital status) were received from Statistics Sweden or the SSIA. Dental care setting, tooth type, and any registration of subsequent restorations within 6 mo were received from the SSIA. Multivariable regression analysis was used, and P < 0.05 was considered statistically significant. In total, 216,764 individuals had been registered with at least 1 root filling. Individuals ( n = 824) without complete data were excluded from the analyses. After 5 y, 9.3% of the root-filled teeth had been registered as extracted. Logistic regression analysis found significant associations for all variables except country of birth, disposable income, and educational level. The highest odds ratios for extractions were associated with the type of restoration: teeth with no registration of any restoration and teeth with a direct restoration combined with a post were 3 times more likely to undergo extraction than teeth restored with an indirect restoration combined with a post and core. Overall, high odds ratios for extractions were associated with any type of composite restoration, including composite fillings and crowns combined with or without any post. In summary, after root filling in the Swedish adult population, several individual- and tooth-specific variables were associated with extraction. The reasons for the extractions remain to be studied further.

scholarly journals Contemporary fatherhood: Social, demographic and attitudinal factors associated with involved fathering and long work hours

2017 ◽  
Vol 54 (4) ◽  
pp. 591-608 ◽  
Author(s):  
Laetitia Coles ◽  
Belinda Hewitt ◽  
Bill Martin
Keyword(s):  
Household Income ◽  
Work Hours ◽  
Factors Associated ◽  
Attitudinal Factors ◽  
Male Breadwinner ◽  
Long Work Hours ◽  
Social Demographic

Time pressures around work and care within families have increased over recent decades, exacerbated by an enduring male breadwinner culture in Australia and manifested in increasingly long work hours for fathers. We identified fathers who spent relatively long hours actively caring for children despite long work hours and we compared them with other fathers who did less work, less childcare, or less of both. Using 13 waves of the Household Income and Labour Dynamics in Australia (HILDA) survey, we explored characteristics associated with the time fathers spent in work and care. The age and ethnicity of fathers differentiated those who spent long hours in both work and childcare from all other groups of fathers, yet other factors were also important for the time fathers spent at work or with children. By examining fathers at the margins of the distributions of work and childcare hours, we add valuable insights into associations between work and care for families.

ASTHMA IN OLDER PATIENTS: FACTORS ASSOCIATED WITH HOSPITALIZATION

PEDIATRICS ◽  
2003 ◽  
Vol 112 (Supplement_2) ◽  
pp. 477-477
Author(s):  
Allen Adinoff
Keyword(s):  
Older Patients ◽  
Factors Associated
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