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

Brian G Arndt; John W Beasley; Michelle D Watkinson; Jonathan L Temte; Wen-Jan Tuan; Christine A Sinsky; Valerie J Gilchrist

doi:10.1370/afm.2121

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

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

Authors

Brian G Arndt¹, John W Beasley^{2

3}, Michelle D Watkinson², Jonathan L Temte², Wen-Jan Tuan², Christine A Sinsky⁴, Valerie J Gilchrist²

Affiliations

¹ School of Medicine and Public Health, Department of Family Medicine and Community Health, University of Wisconsin, Madison, Wisconsin brian.arndt@fammed.wisc.edu.
² School of Medicine and Public Health, Department of Family Medicine and Community Health, University of Wisconsin, Madison, Wisconsin.
³ University of Wisconsin College of Engineering, Department of Industrial and Systems Engineering, Madison, Wisconsin.
⁴ American Medical Association, Chicago, Illinois.

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.

Publication types

Evaluation Study

MeSH terms

Adult
Burnout, Professional / etiology
Electronic Health Records / statistics & numerical data*
Female
Humans
Male
Middle Aged
Physicians, Primary Care / psychology
Physicians, Primary Care / statistics & numerical data*
Primary Health Care / methods*
Retrospective Studies
Time and Motion Studies*
Workload / psychology
Workload / statistics & numerical data*