![]() Previous studies have shown that for a mostly middle-aged, insured population, family physicians address 2.5 to 3.1 issues in the average clinic visit. 25 Heavy EHR use in primary care is associated with increased time pressure, increased physician stress, and decreased job satisfaction. A recent study of four types of physicians found that 27% of their time was spent in clinical face-to-face time with the patient and 49% of their time was spent using the EHR and other deskwork. 12-24 Although several studies of the impact of EHRs on physician work report an effect on time as a percentage of their work day, almost no previous studies measured the actual time spent. Major studies of the work US family physicians perform in their clinic have been published, but all before the national growth of EHRs. 8-10 There is little to no evidence that patient outcomes are improved or overall health care costs are reduced. 1 Reviews of the effect of EHRs on patient and physician outcomes have been mixed, including neutral to small positive effects on common quality metrics and disease-specific guidelines, 2-5 mixed on office workflow, 2,6,7 and mostly decreased on primary care physician productivity. Multivariable linear regression analysis revealed many factors associated with total visit time including patient, physician, and clinic infrastructure factors.Ĭonclusions: Primary care physicians spent more time working in the EHR than they spent in face-to-face time with patients in clinic visits.Ī survey by the Office of the National Coordinator for Health Information Technology in 2014 reported that 87% of primary care physicians used electronic health records (EHRs). The total time and total EHR time varied only slightly between faculty physicians, third-year and second-year residents. The mean time components included 2.9 (3.8) minutes working in the EHR prior to entering the room, 16.5 (9.2) minutes of face-to-face time not working in the EHR, 2.0 (2.1) minutes working in the EHR in the room (which occurred in 73.4% of the visits), 7.5 (7.5) minutes of non-face time (mostly EHR time), and 6.9 (7.6) minutes of EHR work outside of normal clinic operational hours (which occurred in 64.6% of the visits). Results: The mean (SD) visit length was 35.8 (16.6) minutes, not counting resident precepting time. We measured total visit time, previsit chart time, face-to-face time, non-face time, out-of-hours EHR work time, and total EHR work time. The FPs were purposely chosen to reflect a diversity of patient care styles. Methods: We directly observed family physician (FP) attendings, residents, and their ambulatory patients in 982 visits in clinics affiliated with 10 residencies of the Residency Research Network of Texas. ![]() ![]() In this study, we update previous research on the time required to care for patients in primary care clinics with EHRs. Background and Objectives: Electronic health records (EHRs) have had mixed effects on the workflow of ambulatory primary care.
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