National estimates of the impact of electronic health records on the workload of primary care physicians

Abstract

Background: Eighty-four thousand primary care physicians have received $1.3 billion in HITECH payments for EHR adoption. However, little is known about how this will impact primary care workload efficiency and the national primary care shortage. This study examines whether EHR is associated with increases in face time with the patient per visit and increases in the physician's patient volume per week.

Methods: We used a nationally representative sample of 37,962 patient visits to 1470 primary care physicians during the pre-HITECH years 2006-2009 from the restricted-access version of the National Ambulatory Medical Care Survey. Quantile regressions were used to estimate the effects of EHR use on patient face time per visit and physician's patient volume per week at different points of the time and volume distributions.

Results: Primary care physicians with EHR spend an extra 1.3 face time minutes per visit, or 1.5 extra hours per week. This is 34,000 extra hours of face time per week in the U.S. However, physician age matters. Among young physicians, EHR use is associated with a decline in weekly patient volume, while EHR use among older physicians is associated with an increase in volume, regardless of initial practice size. If younger physicians behaved like older physicians when adopting EHR, there would be 37,600 additional patient visits per week in the U.S., the equivalent of adding 500 more primary care physicians to the U.S. workforce.

Conclusion: EHR can enhance productivity/efficiency in primary care physician workloads.

Keywords: Efficiency of care; Electronic health records; Physician workload; Primary care.

Fig. 1

The estimated effect of EHR on patient face time. Note: Effects were estimated using the Table 2 quantile regressions controlling for patient and physician characteristics. All points are significantly different from zero at the p < .05 level except for 10 and 15 min visits for older physicians

Fig. 2

The effect of EHR on physician’s number of patient visits per week. Note: Effects were estimated using the Table 3 quantile regressions controlling for patient and physician characteristics. The average effect for older physicians is significantly different from zero at p = 0.02. The average effect for young physicians is significantly different from zero at p = 0.09. The average effect for middle age physicians is not significantly different from zero