Physician Time Spent Using the Electronic Health Record During Outpatient Encounters

Abstract Electronic health record (EHR) log data have shown promise in measuring physician time spent on clinical activities, contributing to deeper understanding and further optimization of the clinical environment. In this article, we propose 7 core measures of EHR use that reflect multiple dimensions of practice efficiency: total EHR time, work outside of work, time on documentation, time on prescriptions, inbox time, teamwork for orders, and an aspirational measure for the amount of undivided attention patients receive from their physicians during an encounter, undivided attention. We also illustrate sample use cases for these measures for multiple stakeholders. Finally, standardization of EHR log data measure specifications, as outlined here, will foster cross-study synthesis and comparative research.

Download Full-text

Physician Time Spent Using the Electronic Health Record During Outpatient Encounters

Annals of Internal Medicine ◽

10.7326/l20-0278 ◽

2020 ◽

Vol 173 (7) ◽

pp. 594-595

Author(s):

J. Marc Overhage ◽

David McCallie

Keyword(s):

Electronic Health Record ◽

Health Record ◽

Physician Time ◽

Electronic Health

Download Full-text

The electronic health record audit file: the patient is waiting

Journal of the American Medical Informatics Association ◽

10.1093/jamia/ocw088 ◽

2016 ◽

Vol 24 (e1) ◽

pp. e28-e34 ◽

Cited By ~ 7

Author(s):

Annemarie G Hirsch ◽

J B Jones ◽

Virginia R Lerch ◽

Xiaoqin Tang ◽

Andrea Berger ◽

...

Keyword(s):

Electronic Health Record ◽

Wait Time ◽

Clinical Encounter ◽

Health Record ◽

Clinical Workflow ◽

Waiting Room ◽

Exam Room ◽

Physician Time ◽

Nurse Time ◽

Electronic Health

Objective: We describe how electronic health record (EHR) audit files can be used to understand how time is spent in primary care (PC). Materials/methods: We used audit file data from the Geisinger Clinic to quantify elements of the clinical workflow and to determine how these times vary by patient and encounter factors. We randomly selected audit file records representing 36 437 PC encounters across 26 clinic locations. Audit file data were used to estimate duration and variance of: (1) time in the waiting room, (2) nurse time with the patient, (3) time in the exam room without a nurse or physician, and (4) physician time with the patient. Multivariate modeling was used to test for differences by patient and by encounter features. Results: On average, a PC encounter took 54.6 minutes, with 5 minutes of nurse time, 15.5 minutes of physician time, and the remaining 62% of the time spent waiting to see a clinician or check out. Older age, female sex, and chronic disease were associated with longer wait times and longer time with clinicians. Level of service and numbers of medications, procedures, and lab orders were associated with longer time with clinicians. Late check-in and same-day visits were associated with shorter wait time and clinician time. Conclusions: This study provides insights on uses of audit file data for workflow analysis during PC encounters. Discussion: Scalable ways to quantify clinical encounter workflow elements may provide the means to develop more efficient approaches to care and improve the patient experience.

Download Full-text