Pizziferri L et al. 2005 "Primary care physician time utilization before and after implementation of an electronic health record: a time-motion study."
Reference
Pizziferri L, Kittler AF, Volk LA, et al. Primary care physician time utilization before and after implementation of an electronic health record: a time-motion study. J Biomed Inf 2005;38(3):176-188.
Abstract
"Despite benefits associated with the use of electronic health records (EHR's), one major barrier to adoption is the concern that EHR's may take longer for physicians to use than paper-based systems. To address this issue, we performed a time-motion study in five primary care clinics. Twenty physicians were observed and specific activities were timed during a clinic session before and after EHR implementation. Surveys evaluated physicians' perceptions regarding the EHR. Post-implementation, the adjusted mean overall time spent per patient during clinic sessions decreased by 0.5 min (p=0.86; 95% confidence interval [-5.05, 6.04]) from a pre-intervention adjusted average of 27.55 min (SE = 2.1) to a post-intervention adjusted average of 27.05 min (SE = 1.6). A majority of survey respondents believed EHR use results in quality improvement, yet only 29% reported that EHR documentation takes the same amount of time or less compared to the paper-based system. While the EHR did not require more time for physicians during a clinic session, further studies should assess the EHR's potential impact on non-clinic time."
Objective
To evaluate "the effect of the EHR on physicians' overall time in clinic sessions [and] how converting from a paper record to an electronic record affects the time the physicians spend in direct care with patients."
Type Clinic
Primary care
Type Specific
Internal medicine
Size
Large
Geography
Urban and suburban
Other Information
Five clinics in Boston were involved in the study: two were in an urban area and three were in a suburban area. All were part of the Partners Health Care System, including "hospital-based practices, off-site practices and neighborhood health centers."
Type of Health IT
Electronic health records (EHR)
Type of Health IT Functions
The EHR is a Web-based application that "allows the provider to maintain the patient record electronically...[It] incorporates structured patient clinical data, such as medications, allergies, problem lists, and health maintenance items, and tools such as charting, results management, referral management, and order entry. [The EHR] also offers computerized decision support and individualized reminders for health maintenance."
Workflow-Related Findings
"Respondents also rated the [EHR] on a scale from 1 to 5, with 1 being the worst and 5 being the best.... The scores indicated that the physicians believed the [EHR] resulted in an improvement in many domains relating to quality, access, and communication (all means were greater than 4.1). The only item rated below neutral was the [EHR]'s impact on workload with a mean rating of 2.9.... The mean overall satisfaction score [of the EHR] was 3.5."
"Post-implementation, the adjusted mean overall time spent per patient during clinic sessions decreased by 0.5 min (p = 0.86; 95% confidence interval [-5.05, 6.04]) from a pre-intervention adjusted average of 27.55 mins (SE = 2.1) to a post-intervention adjusted average of 27.05 min (SE = 1.6)."
"Overall there was no significant change (13.4 min vs. 13.6 min; p = 0.86) in the time spent in Direct Patient Care post-implementation. The majority of time within Direct Patient Care was spent examining and talking to the patient. Time spent generally talking to the patient or patient's family and educating the patient was essentially the same pre- and post-[implementation]: the mean time per patient was 8.75 min pre-implementation and 8.58 min post-implementation. Examinations and procedures of the patient performed in clinic took slightly less time post-implementation: 4.23 min vs. 3.51 min post-implementation."
"Post-implementation, physicians still needed to perform some tasks using paper [and] physicians were not prohibited from performing tasks using ... paper-based methods. The mean time per patient spent in computer-based Indirect Patient Care activities increased post-implementation, from 0.95 to 5.11 min per patient. Indirect Patient Care activities performed on paper took a mean of 7.60 min per patient pre-[EHR] and 3.72 min post-[EHR]. Time spent on the phone in Indirect Patient Care decreased post-implementation (1.21 min per patient vs. 0.38 min per patient). While the distribution of time spent in Indirect Patient Care activities performed via computer, paper, and phone computer, paper, and phone activities changed post-implementation, the total amount of time spent per patient to perform these activities combined was similar."
"Fifteen of the 23 respondents reported that documentation was performed outside of the clinic session for a mean of 66% of patients (ranged from 20 to 100%). Physicians reported a mean of 9.9 min/established patient to complete documentation post-[implementation] versus 6.9 min pre-[implementation]."
Study Design
Pre-postintervention (no control group)
Study Participants
Twenty physicians were observed preimplementation. Of this 20, 16 were observed postimplementation. Four additional physicians not observed in the preimplementation phase were recruited to take the place of the four that did not participate in postimplementation observations.