To capture the scope and workload of academic primary care physicians in the era of electronic medical record (EMR) by combining direct workflow observations with time analysis of activities outside the clinic encounter
Method:
The study conducted in March 2011 at University of California at San Diego. It included standardized direct workflow observations of patients, staff, and physician. Data included detailed time-motion analyses of EMR activities including E-prescriptions, E-mail, lab imaging consultations, and documentation functions. Volume of extra-clinical patient care activities are logged into and date and time-stamped by the EMR, captured via administrative logs for each physician for a 90 day period.
Data reflecting each physician's percent of time in clinical activities was converted to a full time equivalent (FTE), and a multiplier of the FTE was applied to the number of tasks performed. The converted numbers of tasks then converted to hours per categorical task per 90 day period. Using U.S. Bureau of Statistics, the 90 day periods were converted into annualized hours per task category. Using the assumption of 18.5 workdays/ month, with each workday 8.1 hours long, the annualized hours were converted to an average clinical workday. The gender and part-time vs. full-time status of the physicians were compared with the results of the workload data via student's T-tests.
Result:
For every 8 hours of direct patient care time, physicians spent an average of 3:55 hours (3:00-4:10 hours) engaged in various forms of documenting and responding to clinical communications. Phone calls accounted for 1:40 hours of time (1:33-1:68 hours), with assessing laboratory results accounting for 0:73 hours (0:57-0:95 hours) and e-prescriptions accounting for 0:54 hours (0:51-0:66). No significant differences found in gender or work status of the physicians. Time required for physician clinic note completion was not included in this study.
Conclusion:
Academic primary care internal medicine physicians in this study spent significant time responding to communications and documenting the management of their patients’ health outside the clinic face to face encounter when utilizing EMRs. With impending shortages of primary care physicians and burnout in primary care, there is an urgent need to address the large amount of physician's workload occurring outside the clinical encounter.
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