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- Title
System-Level Factors and Time Spent on Electronic Health Records by Primary Care Physicians.
- Authors
Rotenstein, Lisa S.; Holmgren, A. Jay; Horn, Daniel M.; Lipsitz, Stuart; Phillips, Russell; Gitomer, Richard; Bates, David W.
- Abstract
Key Points: Question: How are specific primary care physician (PCP), patient panel, clinic, and team collaboration factors associated with PCPs' electronic health record (EHR) time? Findings: In this cross-sectional study of 307 PCPs across 31 primary care practices at Massachusetts General Hospital and Brigham and Women's Hospital during 2021, organization-level factors, such as greater team collaboration on orders, the presence of specific clinic staff, and practicing in a community health center, were associated with significantly lower per-visit EHR time across multiple categories. Meaning: These findings suggest the importance of addressing EHR burden at a systems level. This cross-sectional study assesses the time primary care physicians spent on the electronic health record in 31 primary care clinics in 2 academic medical center–based primary care networks in 2021. Importance: Primary care physicians (PCPs) spend the most time on the electronic health record (EHR) of any specialty. Thus, it is critical to understand what factors contribute to varying levels of PCP time spent on EHRs. Objective: To characterize variation in EHR time across PCPs and primary care clinics, and to describe how specific PCP, patient panel, clinic, and team collaboration factors are associated with PCPs' time spent on EHRs. Design, Setting, and Participants: This cross-sectional study included 307 PCPs practicing across 31 primary care clinics at Massachusetts General Hospital and Brigham and Women's Hospital during 2021. Data were analyzed from October 2022 to October 2023. Main Outcomes and Measures: Total per-visit EHR time, total per-visit pajama time (ie, time spent on the EHR between 5:30 pm to 7:00 am and on weekends), and total per-visit time on the electronic inbox as measured by activity log data derived from an EHR database. Results: The sample included 307 PCPs (183 [59.6%] female). On a per-visit basis, PCPs spent a median (IQR) of 36.2 (28.9-45.7) total minutes on the EHR, 6.2 (3.1-11.5) minutes of pajama time, and 7.8 (5.5-10.7) minutes on the electronic inbox. When comparing PCP time expenditure by clinic, median (IQR) total EHR time, median (IQR) pajama time, and median (IQR) electronic inbox time ranged from 23.5 (20.7-53.1) to 47.9 (30.6-70.7) minutes per visit, 1.7 (0.7-10.5) to 13.1 (7.7-28.2) minutes per visit, and 4.7 (4.1-5.2) to 10.8 (8.9-15.2) minutes per visit, respectively. In a multivariable model with an outcome of total per-visit EHR time per visit, an above median percentage of teamwork on orders was associated with 3.81 (95% CI, 0.49-7.13) minutes per visit fewer and having a clinic pharmacy technician was associated with 7.87 (95% CI, 2.03-13.72) minutes per visit fewer. Practicing in a community health center was associated with fewer minutes of total EHR time per visit (5.40 [95% CI, 0.06-10.74] minutes). Conclusions and Relevance: There is substantial variation in EHR time among individual PCPs and PCPs within clinics. Organization-level factors, such as team collaboration on orders, support for medication refill functions, and practicing in a community health center, are associated with lower EHR time for PCPs. These findings highlight the importance of addressing EHR burden at a systems level.
- Subjects
CONFIDENCE intervals; TIME; CROSS-sectional method; COMPARATIVE studies; INTERPROFESSIONAL relations; DESCRIPTIVE statistics; ELECTRONIC health records
- Publication
JAMA Network Open, 2023, Vol 6, Issue 11, pe2344713
- ISSN
2574-3805
- Publication type
Article
- DOI
10.1001/jamanetworkopen.2023.44713