Domain

Analytic Methods

Type

Empirical Study

Theme

operations

Start Date

7-6-2014 1:15 PM

End Date

7-6-2014 2:45 PM

Structured Abstract

Background

Understanding how physicians, and particularly PCPs, spend their time during clinical work is essential, given the need to improve the accuracy of physician payment under the physician fee schedule. EpicCare Electronic Health Record (EHR) data offers clues on how clinicians use time, a critical resource in health services delivery. Prevailing means of studying physician time use during clinical encounters (e.g., direct observation or surveys) are costly and can overlook pre-service and post-service work. The routine creation of access logs by EpicCare EHR generates the underlying data allowing researchers an alternative, unobtrusive portal to study time use.

Methods

We used EHR access log data associated with 22,271 patients occurring in one month in 2013 by 49 physicians in two primary care departments in a large group practice to explore individual physicians’ patterns of time allocation on different tasks.

Results

The access log allows a characterization of 67.14% of physicians’ work time in clinic that can be attributed to patient care; of which 54.38% was spent on services associate with face-to-face visits with patients: 36.65% involved visits themselves and 17.73% in pre and post visit service activities. Time spent on services for patients not seen on the day of the EHR activities accounted for 12.77% of the time which covered 6.72% on telephone calls, 3.05% on secure messaging to patients, 1.45% prescription refills, and 0.78% on orders for labs or referrals. For each in-person patient visit, an average of 16.4 minutes was logged in the exam room and 7.9 minutes logged outside of the exam room.

Conclusions:

EHR log data can be a valuable resource to study physician work efforts. The time in face-to-face visits estimated from the logs is consistent with direct observations. Logs capture the significant amount of time clinicians spend on patient care activities outside of office visits. The increasing focus on “desktop medicine” to engage patients and coordinate care using phone and EHR demands provider payment mechanisms to account for work outside of face-to-face patient visits.

Acknowledgements

AHRQ HS019167

Creative Commons License

Creative Commons Attribution-Noncommercial-No Derivative Works 3.0 License
This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 3.0 License.

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Jun 7th, 1:15 PM Jun 7th, 2:45 PM

Stamps from an Epic Journey: Physician Work Efforts Reflected by Over Three Million Primary Care Transactions in an Electronic Health Record

Background

Understanding how physicians, and particularly PCPs, spend their time during clinical work is essential, given the need to improve the accuracy of physician payment under the physician fee schedule. EpicCare Electronic Health Record (EHR) data offers clues on how clinicians use time, a critical resource in health services delivery. Prevailing means of studying physician time use during clinical encounters (e.g., direct observation or surveys) are costly and can overlook pre-service and post-service work. The routine creation of access logs by EpicCare EHR generates the underlying data allowing researchers an alternative, unobtrusive portal to study time use.

Methods

We used EHR access log data associated with 22,271 patients occurring in one month in 2013 by 49 physicians in two primary care departments in a large group practice to explore individual physicians’ patterns of time allocation on different tasks.

Results

The access log allows a characterization of 67.14% of physicians’ work time in clinic that can be attributed to patient care; of which 54.38% was spent on services associate with face-to-face visits with patients: 36.65% involved visits themselves and 17.73% in pre and post visit service activities. Time spent on services for patients not seen on the day of the EHR activities accounted for 12.77% of the time which covered 6.72% on telephone calls, 3.05% on secure messaging to patients, 1.45% prescription refills, and 0.78% on orders for labs or referrals. For each in-person patient visit, an average of 16.4 minutes was logged in the exam room and 7.9 minutes logged outside of the exam room.

Conclusions:

EHR log data can be a valuable resource to study physician work efforts. The time in face-to-face visits estimated from the logs is consistent with direct observations. Logs capture the significant amount of time clinicians spend on patient care activities outside of office visits. The increasing focus on “desktop medicine” to engage patients and coordinate care using phone and EHR demands provider payment mechanisms to account for work outside of face-to-face patient visits.