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. 2017 Sep;15(5):419-426.
doi: 10.1370/afm.2121.

Tethered to the EHR: Primary Care Physician Workload Assessment Using EHR Event Log Data and Time-Motion Observations

Brian G Arndt  1 , John W Beasley  2   3 , Michelle D Watkinson  2 , Jonathan L Temte  2 , Wen-Jan Tuan  2 , Christine A Sinsky  4 , Valerie J Gilchrist  2
Affiliations

Tethered to the EHR: Primary Care Physician Workload Assessment Using EHR Event Log Data and Time-Motion Observations

Brian G Arndt et al. Ann Fam Med. 2017 Sep.

Abstract

Purpose: Primary care physicians spend nearly 2 hours on electronic health record (EHR) tasks per hour of direct patient care. Demand for non-face-to-face care, such as communication through a patient portal and administrative tasks, is increasing and contributing to burnout. The goal of this study was to assess time allocated by primary care physicians within the EHR as indicated by EHR user-event log data, both during clinic hours (defined as 8:00 am to 6:00 pm Monday through Friday) and outside clinic hours.

Methods: We conducted a retrospective cohort study of 142 family medicine physicians in a single system in southern Wisconsin. All Epic (Epic Systems Corporation) EHR interactions were captured from "event logging" records over a 3-year period for both direct patient care and non-face-to-face activities, and were validated by direct observation. EHR events were assigned to 1 of 15 EHR task categories and allocated to either during or after clinic hours.

Results: Clinicians spent 355 minutes (5.9 hours) of an 11.4-hour workday in the EHR per weekday per 1.0 clinical full-time equivalent: 269 minutes (4.5 hours) during clinic hours and 86 minutes (1.4 hours) after clinic hours. Clerical and administrative tasks including documentation, order entry, billing and coding, and system security accounted for nearly one-half of the total EHR time (157 minutes, 44.2%). Inbox management accounted for another 85 minutes (23.7%).

Conclusions: Primary care physicians spend more than one-half of their workday, nearly 6 hours, interacting with the EHR during and after clinic hours. EHR event logs can identify areas of EHR-related work that could be delegated, thus reducing workload, improving professional satisfaction, and decreasing burnout. Direct time-motion observations validated EHR-event log data as a reliable source of information regarding clinician time allocation.

Keywords: burnout; electronic health records; health information technology; practice-based research; primary care; workload.

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Conflict of interest statement

Conflicts of interest: authors report none.

Figures

Figure 1
Figure 1
Screenshot of WorkStudy+ application for the iPad. Note: For direct observation, we developed 15 electronic health record (EHR) task categories plus several non-EHR task categories (eg, staff interactions, e-mail, paperwork and other administrative work, and personal time). Some of the categories shown have further subcategories that appear once the category is selected.
Figure 2
Figure 2
Family physicians’ EHR use by time of day. EHR=electronic health record.
See this image and copyright information in PMC

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