Characterization of EHR Use Outside Work Hours among Primary Care Pediatricians Using Electronic Health Record Access Logs (Preprint)

2021 ◽  
Author(s):  
Selasi Attipoe ◽  
Jeffrey Hoffman ◽  
Steve Rust ◽  
Yungui Huang ◽  
John A. Barnard ◽  
...  
Keyword(s):  
Primary Care ◽  
Mixed Effects ◽  
Work Hours ◽  
Full Time ◽  
Negative Consequences ◽  
Full Time Equivalent ◽  
Log Data ◽  
Other Information ◽  
Electronic Health ◽  
Primary Care Pediatricians

BACKGROUND Many of the benefits of electronic health records (EHRs) have not been achieved at expected levels due to a variety of unintended negative consequences such as documentation burden. Previous studies have characterized EHR use during and outside work hours, with many reporting physicians spending considerable time on documentation-related tasks. These studies characterized EHR use during and outside work hours using clock time versus actual physician schedules to define outside work time. OBJECTIVE This study closes a knowledge gap by characterizing EHR engagement outside work hours using actual physician schedules to define EHR work outside work hours. METHODS A retrospective exploratory descriptive task analysis of EHR access log data from primary care pediatricians in September 2019 at a large midwestern pediatric health center was conducted to quantify and identify actions completed outside work hours. Mixed effects statistical modeling was used to investigate the effects of age, sex, clinical full-time equivalent status, and EHR engagement during work hours on the use of EHRs outside work hours. RESULTS Primary care pediatricians (n=56) in this study generated a total of 1,523,872 access-log data points (across 1,069 physician workdays) and spent an average of 3.9 and 1.2 hours per physician per workday engaged in the EHR during and outside work hours, respectively. About three-quarters of the time engaged in the EHR during or outside work hours was spent reviewing data and reports. Mixed effects regression revealed no associations of age, sex, nor clinical full-time equivalent status with EHR use during or outside work hours. CONCLUSIONS For every hour primary care pediatricians in this study spent engaged with the EHR during work hours, they spent about 20 minutes interacting with the EHR outside work hours. Most of their time (both during and outside of work hours) was spent reviewing data, records, and other information in the EHR.

scholarly journals Electronic health records and burnout: Time spent on the electronic health record after hours and message volume associated with exhaustion but not with cynicism among primary care clinicians

2020 ◽  
Vol 27 (4) ◽  
pp. 531-538 ◽  
Author(s):  
Julia Adler-Milstein ◽  
Wendi Zhao ◽  
Rachel Willard-Grace ◽  
Margae Knox ◽  
Kevin Grumbach
Keyword(s):  
Primary Care ◽  
Electronic Health Record ◽  
Academic Medical Center ◽  
Maslach Burnout Inventory ◽  
Health Record ◽  
Full Time ◽  
Full Time Equivalent ◽  
After Hours ◽  
Electronic Health ◽  
High Exhaustion

Abstract Objectives The study sought to determine whether objective measures of electronic health record (EHR) use—related to time, volume of work, and proficiency—are associated with either or both components of clinician burnout: exhaustion and cynicism. Materials and Methods We combined Maslach Burnout Inventory survey measures (94% response rate; 122 of 130 clinicians) with objective, vendor-defined EHR use measures from log files (time after hours on clinic days; time on nonclinic days; message volume; composite measures of efficiency and proficiency). Data were collected in early 2018 from all primary care clinics of a large, urban, academic medical center. Multivariate regression models measured the association between each burnout component and each EHR use measure. Results One-third (34%) of clinicians had high cynicism and 51% had high emotional exhaustion. Clinicians in the top 2 quartiles of EHR time after hours on scheduled clinic days (those above the sample median of 68 minutes per clinical full-time equivalent per week) had 4.78 (95% confidence interval [CI], 1.1-20.1; P = .04) and 12.52 (95% CI, 2.6-61; P = .002) greater odds of high exhaustion. Clinicians in the top quartile of message volume (>307 messages per clinical full-time equivalent per week) had 6.17 greater odds of high exhaustion (95% CI, 1.1-41; P = .04). No measures were associated with high cynicism. Discussion EHRs have been cited as a contributor to clinician burnout, and self-reported data suggest a relationship between EHR use and burnout. As organizations increasingly rely on objective, vendor-defined EHR measures to design and evaluate interventions to reduce burnout, our findings point to the measures that should be targeted. Conclusions Two specific EHR use measures were associated with exhaustion.

Workforce demographics and unit structure in paediatric cardiac critical care in the United States

2021 ◽  
pp. 1-5
Author(s):  
Robin V. Horak ◽  
Shasha Bai ◽  
Bradley S. Marino ◽  
David K. Werho ◽  
Leslie A. Rhodes ◽  
...  
Keyword(s):  
United States ◽  
Critical Care ◽  
Heart Surgery ◽  
Age Groups ◽  
The United States ◽  
Work Hours ◽  
Full Time ◽  
Full Time Equivalent ◽  
Unit Structure ◽  
Cardiac Critical Care

Abstract Objective: To assess current demographics and duties of physicians as well as the structure of paediatric cardiac critical care in the United States. Design: REDCap surveys were sent by email from May till August 2019 to medical directors (“directors”) of critical care units at the 120 United States centres submitting data to the Society of Thoracic Surgeons Congenital Heart Surgery Database and to associated faculty from centres that provided email lists. Faculty and directors were asked about personal attributes and clinical duties. Directors were additionally asked about unit structure. Measurements and main results: Responses were received from 66% (79/120) of directors and 62% (294/477) of contacted faculty. Seventy-six percent of directors and 54% of faculty were male, however, faculty <40 years old were predominantly women. The majority of both groups were white. Median bed count (n = 20) was similar in ICUs and multi-disciplinary paediatric ICUs. The median service expectation for one clinical full-time equivalent was 14 weeks of clinical service (interquartile range 12, 16), with the majority of programmes (86%) providing in-house attending night coverage. Work hours were high during service and non-service weeks with both directors (37%) and faculty (45%). Conclusions: Racial and ethnic diversity is markedly deficient in the paediatric cardiac critical care workforce. Although the majority of faculty are male, females make up the majority of the workforce younger than 40 years old. Work hours across all age groups and unit types are high both on- and off-service, with most units providing attending in-house night coverage.

scholarly journals Measuring Electronic Health Record Use in the Pediatric ICU Using Audit-Logs and Screen Recordings

2021 ◽  
Vol 12 (04) ◽  
pp. 737-744
Author(s):  
Amrita Sinha ◽  
Lindsay A. Stevens ◽  
Felice Su ◽  
Natalie M. Pageler ◽  
Daniel S. Tawfik
Keyword(s):  
Electronic Health Record ◽  
Pediatric Intensive Care ◽  
Clinical Activity ◽  
Inpatient Setting ◽  
Health Record ◽  
Full Time ◽  
Care Providers ◽  
Provider Type ◽  
Full Time Equivalent ◽  
Electronic Health

Abstract Background Time spent in the electronic health record (EHR) has been identified as an important unit of measure for health care provider clinical activity. The lack of validation of audit-log based inpatient EHR time may have resulted in underuse of this data in studies focusing on inpatient patient outcomes, provider efficiency, provider satisfaction, etc. This has also led to a dearth of clinically relevant EHR usage metrics consistent with inpatient provider clinical activity. Objective The aim of our study was to validate audit-log based EHR times using observed EHR-times extracted from screen recordings of EHR usage in the inpatient setting. Methods This study was conducted in a 36-bed pediatric intensive care unit (PICU) at Lucile Packard Children's Hospital Stanford between June 11 and July 14, 2020. Attending physicians, fellow physicians, hospitalists, and advanced practice providers with ≥0.5 full-time equivalent (FTE) for the prior four consecutive weeks and at least one EHR session recording were included in the study. Citrix session recording player was used to retrospectively review EHR session recordings that were captured as the provider interacted with the EHR. Results EHR use patterns varied by provider type. Audit-log based total EHR time correlated strongly with both observed total EHR time (r = 0.98, p < 0.001) and observed active EHR time (r = 0.95, p < 0.001). Each minute of audit-log based total EHR time corresponded to 0.95 (0.87–1.02) minutes of observed total EHR time and 0.75 (0.67–0.83) minutes of observed active EHR time. Results were similar when stratified by provider role. Conclusion Our study found inpatient audit-log based EHR time to correlate strongly with observed EHR time among pediatric critical care providers. These findings support the use of audit-log based EHR-time as a surrogate measure for inpatient provider EHR use, providing an opportunity for researchers and other stakeholders to leverage EHR audit-log data in measuring clinical activity and tracking outcomes of workflow improvement efforts longitudinally and across provider groups.

scholarly journals Regional variation in practitioner employment in general practices in England: a comparative analysis

2020 ◽  
Vol 70 (692) ◽  
pp. e164-e171
Author(s):  
Sharon Spooner ◽  
Jon Gibson ◽  
Kath Checkland ◽  
Anne McBride ◽  
Damian E Hodgson ◽  
...  
Keyword(s):  
Primary Care ◽  
Comparative Analysis ◽  
Regional Variation ◽  
Healthcare Delivery ◽  
Full Time ◽  
Policy Changes ◽  
Full Time Equivalent ◽  
Primary Care Workforce ◽  
Data Extract ◽  
Workforce Composition

BackgroundIn recent years, UK health policy makers have responded to a GP shortage by introducing measures to support increased healthcare delivery by practitioners from a wider range of backgrounds.AimTo ascertain the composition of the primary care workforce in England at a time when policy changes affecting deployment of different practitioner types are being introduced.Design and settingThis study was a comparative analysis of workforce data reported to NHS Digital by GP practices in England.MethodStatistics are reported using practice-level data from the NHS Digital June 2019 data extract. Because of the role played by Health Education England (HEE) in training and increasing the skills of a healthcare workforce that meets the needs of each region, the analysis compares average workforce composition across the 13 HEE regions in EnglandResultsThe workforce participation in terms of full-time equivalent of each staff group across HEE regions demonstrates regional variation. Differences persist when expressed as mean full-time equivalent per thousand patients. Despite policy changes, most workers are employed in long-established primary care roles, with only a small proportion of newer types of practitioner, such as pharmacists, paramedics, physiotherapists, and physician associates.ConclusionThis study provides analysis of a more detailed and complete primary care workforce dataset than has previously been available in England. In describing the workforce composition at this time, the study provides a foundation for future comparative analyses of changing practitioner deployment before the introduction of primary care networks, and for evaluating outcomes and costs that may be associated with these changes.

The role of app-based remote patient monitoring in reducing primary care clinician workload during the COVID pandemic: A prospective observational real world feasibility study.

2021 ◽  
Author(s):  
Sachin Shailendra Shah ◽  
Afsana Safa ◽  
Kuldhir Johal ◽  
Dillon Obika ◽  
Sophie Valenine
Keyword(s):  
Primary Care ◽  
Patient Monitoring ◽  
Healthcare Providers ◽  
Routine Care ◽  
Full Time ◽  
Remote Patient Monitoring ◽  
Full Time Equivalent ◽  
Phone Calls ◽  
Medium Risk ◽  
Remote Patient

Abstract Background COVID-19 has placed unprecedented strain on healthcare providers, in particular, primary care services. GP practices have to effectively manage patients remotely preserving social distancing. We aim to assess an app-based remote patient monitoring solution in reducing the workload of a clinician. Primary care COVID patients in West London deemed medium risk where recruited into the virtual ward. Patients were monitored for 14 days by telephone or by both the Huma app and telephone. Information on number of phone calls, duration of phone calls and duration of time spent reviewing the app data recorded.Results The amount of time spent reviewing one patient on the telephone only arm of the study was 490 minutes, compared with 280 minutes spent reviewing one patient who was monitored via both the Huma app and telephone. Based on employed clinicians monitoring patients, this equates to a 0.04 reduction of full-time equivalent staffing I.e. for every 100 patients, it would require 4 less personal to remotely monitor them. There was no difference in mortality or adverse events between the two groups.Conclusion App-based remote patient monitoring clearly holds large economic benefit to COVID-19 patients. In wake of further waves or future pandemics, and even in routine care, app-based remote monitoring patients could free up vital resources in terms of clinical team’s time, allowing a better reallocation of services.

scholarly journals The influence of a Sprint optimization and training intervention on time spent in the electronic health record (EHR)

JAMIA Open ◽  
2021 ◽  
Vol 4 (3) ◽  
Author(s):  
Amber Sieja ◽  
Melanie D Whittington ◽  
Vanessa Paul Patterson ◽  
Katie Markley ◽  
Heather Holmstrom ◽  
...  
Keyword(s):  
Electronic Health Record ◽  
Interrupted Time Series ◽  
Health Record ◽  
Full Time ◽  
Full Time Equivalent ◽  
Post Intervention ◽  
Time Savings ◽  
Electronic Health ◽  
The Impact ◽  
And Training

Abstract Objective We report the influence of Sprint electronic health record (EHR) training and optimization on clinician time spent in the EHR. Materials and Methods We studied the Sprint process in one academic internal medicine practice with 26 providers. Program offerings included individualized training sessions, and the ability to clean up, fix, or build new EHR tools during the 2-week intervention. EHR usage log data were available for 24 clinicians, and the average clinical full-time equivalent was 0.44. We used a quasi-experimental study design with an interrupted time series specification, with 8 months of pre- and 12 months of post-intervention data to evaluate clinician time spent in the EHR. Results We discovered a greater than 6 h per day reduction in clinician time spent in the EHR at the clinic level. At the individual clinician level, we demonstrated a time savings of 20 min per clinician per day among those who attended at least 2 training sessions. Discussion We can promote EHR time savings for clinicians who engage in robust EHR training and optimization programs. To date, programs have shown a positive correlation between participation and subjective EHR satisfaction, efficiency, or time saved. The impact of EHR training and optimization on objective time savings remains elusive. By measuring time in the EHR, this study contributes to an ongoing conversation about the resources and programs needed to decrease clinician EHR time. Conclusions We have demonstrated that Sprint is associated with time savings for clinicians for up to 6 months. We suggest that an investment in EHR optimization and training can pay dividends in clinician time saved.

Status of the medical oncology workforce. The American Society of Clinical Oncology.

1996 ◽  
Vol 14 (9) ◽  
pp. 2612-2621 ◽  
Keyword(s):  
United States ◽  
Primary Care ◽  
Patient Care ◽  
Clinical Oncology ◽  
Medical Oncology ◽  
The United States ◽  
Full Time ◽  
Full Time Equivalent ◽  
Medical Oncologists ◽  
American Society

PURPOSE A survey was designed to determine accurately the number of full-time equivalent medical oncologists in the United States, to determine how medical oncologists in different work settings divide their professional activities, and to determine whether medical oncology represents a primary care specialty in the minds of practicing oncologists. METHODS A questionnaire was mailed to the 4,239 members of the American Society of Clinical Oncology (ASCO) who identified themselves as medical oncologists or hematologists/oncologists and were current residents of the United States. Follow-up letters, which included a second copy of the questionnaire, were sent to nonresponders. A third mailing, followed by a telephone reminder, was sent to a randomly selected subset of 300 nonresponders to be certain that the initial responders were similar in practice patterns and attitudes to those individuals who had not initially completed the survey. RESULTS A total of 2,540 physicians responded to the first mailing and an additional 187 to the second (64% response rate); a further 196 individuals who were directly contacted completed the survey document. Practitioners appear to see 160 to 200 different patients per month and to devote approximately 72% of their time to patient care activities. Research and teaching comprised only 3% to 4% of professional time for physicians in private practice or Health Maintenance Organization (HMO) settings, in contrast to 16% for those who worked in community hospitals. Medical oncologists frequently serve the role of principal care giver while patients are undergoing cancer treatment. However, medical oncologists devote minimal time providing primary care services to patients and, if required to increase their clinical volume, would prefer to care for more cancer patients than enhance their primary care activities. It is estimated that the present full-time equivalent number (ie, the conglomorate number of oncologists based on 100% professional effort devoted to clinical care) of medical oncologists is approximately 3,600 individuals. This translates into 1.8 medical oncologists per 100,000 adult Americans. CONCLUSION The medical oncology community devotes the majority of its time to providing oncologic patient care and does not provide or appear to wish to provide what the public defines as primary care. The survey estimate of 1.8 medical oncologists per 100,000 adult Americans is in close accord with HMO estimates of the number of desired oncologists. Consequently, the supply appears consistent with the anticipated demand. There does not appear to be an oversupply of medical oncologists in the United States.

scholarly journals Physician Burnout and Timing of Electronic Health Record Use

ACI Open ◽  
2020 ◽  
Vol 04 (01) ◽  
pp. e1-e8 ◽  
Author(s):  
Mark A. Micek ◽  
Brian Arndt ◽  
Wen-Jan Tuan ◽  
Elizabeth Trowbridge ◽  
Shannon M. Dean ◽  
...  
Keyword(s):  
Internal Medicine ◽  
Primary Care ◽  
Electronic Health Record ◽  
Work Hours ◽  
Care Practice ◽  
Health Record ◽  
Physician Burnout ◽  
After Hours ◽  
Electronic Health ◽  
The Relationship

Abstract Background Rates of burnout among physicians have been high in recent years. The electronic health record (EHR) is implicated as a major cause of burnout. Objective This article aimed to determine the association between physician burnout and timing of EHR use in an academic internal medicine primary care practice. Methods We conducted an observational cohort study using cross-sectional and retrospective data. Participants included primary care physicians in an academic outpatient general internal medicine practice. Burnout was measured with a single-item question via self-reported survey. EHR time was measured using retrospective automated data routinely captured within the institution's EHR. EHR time was separated into four categories: weekday work-hours in-clinic time, weekday work-hours out-of-clinic time, weekday afterhours time, and weekend/holiday after-hours time. Ordinal regression was used to determine the relationship between burnout and EHR time categories. Results EHR use during in-clinic sessions was related to burnout in both bivariate (odds ratio [OR] = 1.04, 95% confidence interval [CI]: 1.01, 1.06; p = 0.007) and adjusted (OR = 1.07, 95% CI: 1.03, 1.1; p = 0.001) analyses. No significant relationships were found between burnout and after-hours EHR use. Conclusion In this small single-institution study, physician burnout was associated with higher levels of in-clinic EHR use but not after-hours EHR use. Improved understanding of the variability of in-clinic EHR use, and the EHR tasks that are particularly burdensome to physicians, could help lead to interventions that better integrate EHR demands with clinical care and potentially reduce burnout. Further studies including more participants from diverse clinical settings are needed to further understand the relationship between burnout and after-hours EHR use.

Sharing Care: The Psychiatrist in the Family Physician's Office

1997 ◽  
Vol 42 (9) ◽  
pp. 960-965 ◽  
Author(s):  
Nick Kates ◽  
Marilyn A Craven ◽  
Anne-Marie Crustolo ◽  
Lambrina Nikolaou ◽  
Chris Allen ◽  
...  
Keyword(s):  
Primary Care ◽  
Family Physicians ◽  
Primary Care Providers ◽  
Care Practice ◽  
Full Time ◽  
Care Providers ◽  
Full Time Equivalent ◽  
High Satisfaction ◽  
The Family

Objective: One way of strengthening ties between primary care providers and psychiatrists is for a psychiatrist to visit a primary care practice on a regular basis to see and discuss patients and to provide educational input and advice for family physicians. This paper reviews the experiences of a program in Hamilton, Ontario that brings psychiatrists and counsellors into the offices of 88 local family physicians in 36 practices. Method: Data are presented based on the activities of psychiatrists working in 13 practices over a 2-year period. Data were gathered from forms routinely completed by family physicians when making a referral and by psychiatrists whenever they saw a new case. An annual satisfaction questionnaire for all providers participating in the program was also used to gather information. Results: Over a 2-year period, 1021 patients were seen in consultation by one full-time equivalent psychiatrist. The average duration of a consultation was 51 minutes, and a family member was present for 12% of the visits. Twenty-one percent of the patients were seen for at least one follow-up visit, 75% of which were prearranged. In addition, 1515 cases were discussed during these visits without the patient being seen. All participants had a high satisfaction rating for their involvement with the project. Conclusions: Benefits of this approach include increased accessibility to psychiatric consultation, enhanced continuity of care, support for family physicians, and improved communication between psychiatrists and family physicians. This model, which has great potential for innovative approaches to continuing education and resident placements, demands new skills of participating psychiatrists.

scholarly journals A prospective observational real world feasibility study assessing the role of app-based remote patient monitoring in reducing primary care clinician workload during the COVID pandemic

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Sachin Shailendra Shah ◽  
Afsana Safa ◽  
Kuldhir Johal ◽  
Dillon Obika ◽  
Sophie Valentine
Keyword(s):  
Primary Care ◽  
Patient Monitoring ◽  
Healthcare Providers ◽  
Routine Care ◽  
Full Time ◽  
Remote Patient Monitoring ◽  
Full Time Equivalent ◽  
Phone Calls ◽  
Novel Coronavirus ◽  
Remote Patient

Abstract Background The novel coronavirus disease in 2019 (COVID-19) has placed unprecedented strain on healthcare providers, in particular, primary care services. General practitioners (GP) have to effectively manage patients remotely preserving social distancing. We aim to assess an app-based remote patient monitoring solution in reducing the workload of a clinician and reflect this as time-saved in an economic context. Primary care COVID patients in West London deemed medium risk were recruited into the virtual ward. Patients were monitored for 14 days by telephone or by both the Huma app and telephone. Information on number of phone calls, duration of phone calls and duration of time spent reviewing the app data was recorded. Results The amount of time spent reviewing one patient in the telephone only arm of the study was 490 min, compared with 280 min spent reviewing one patient who was monitored via both the Huma app and telephone. Based on employed clinicians monitoring patients, this equates to a 0.04 reduction of full-time equivalent staffing I.e. for every 100 patients, it would require 4 less personnel to remotely monitor them. There was no difference in mortality or adverse events between the two groups. Conclusion App-based remote patient monitoring potentially holds large economic benefit to COVID-19 patients. In wake of further waves or future pandemics, and even in routine care, app-based remote monitoring patients could free up vital resources in terms of clinical team’s time, allowing a better reallocation of services.

Sign in / Sign up

Export Citation Format

Share Document