Tethered to the EHR: Primary Care Physician Workload Assessment Using EHR Event Log Data and TimeMotion Observations
Tethered to the EHR: Primary Care Physician Workload Assessment Using EHR Event Log Data and TimeMotion Observations
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DOI：
10.1370/afm.2121
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发表时间：
2017-09-01
影响因子：
4.4
通讯作者：
Gilchrist, Valerie J.
中科院分区：
文献类型：
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作者：
Arndt, Brian G.;Beasley, John W.;Gilchrist, Valerie J.
初级保健医生每小时的直接病人护理花费近2小时的电子健康记录（EHR）任务。对非面对面护理的需求，如通过患者门户网站和管理任务进行沟通，正在增加，并导致倦怠。本研究的目标是评估分配的时间由初级保健医生在EHR内的EHR userevent日志数据，无论是在门诊时间（定义为上午8：00至下午6：00周一至周五）和门诊hours.METHODS外，我们进行了回顾性队列研究，142个家庭医学医生在一个单一的系统在南部威斯康星州。所有Epic（Epic Systems Corporation）EHR交互都是从3年期间的“事件日志”记录中捕获的，用于直接患者护理和非面对面活动，并通过直接观察进行验证。EHR事件被分配到15个EHR任务类别之一，并分配到无论是在或之后clinic hours.Results临床医生花了355分钟（5.9小时）的11.4小时的工作日在EHR每个工作日每1.0临床全职当量：269分钟（4.5小时）在门诊时间和86分钟（1.4小时）后门诊时间。文书和行政任务，包括文档、订单输入、计费和编码以及系统安全，占电子健康记录总时间的近一半（157分钟，44.2%）。电子病历管理占另外85分钟（23.7%）。结论初级保健医生花了一半以上的工作日，近6个小时，与EHR在门诊期间和之后的时间。EHR事件日志可以确定可以委托的EHR相关工作领域，从而减少工作量，提高专业满意度，并减少倦怠。直接的时间运动观察验证了EHR事件日志数据作为临床医生时间分配的可靠信息来源。
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 userevent 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.