Physician activity during outpatient visits and subjective workload

Area of Science:

• Medical Informatics
• Human-Computer Interaction
• Health Services Research

Background:

• Understanding physician workload and clinical workflow is crucial for optimizing Electronic Health Record (EHR) system design and implementation.
• Current methods for analyzing physician activity during patient encounters are often limited in scope and temporal resolution.

Purpose of the Study:

• To develop and validate methods for capturing and analyzing physician EHR use and clinical workflow during outpatient encounters.
• To correlate objective activity measures with physicians' self-reported workload.

Main Methods:

• Collected temporally-resolved data including audio, video, EHR activity, and eye-gaze from physicians in primary care and specialty clinics.
• Utilized manual content analysis and computational techniques to align data streams and derive process measures.
• Administered the NASA Task Load Index survey to assess subjective physician workload.

Main Results:

• Identified similar patterns of EHR use and navigation across different EHR platforms (CPRS and Epic) despite interface variations.
• Observed significant variability in physician activity and its correlation with subjective workload.
• Found comparable proportions of EHR function use, navigation, visit length, and physician attention to EHRs (gaze) across sites.

Conclusions:

• The developed methodology allows for detailed analysis of clinical workflow and EHR interaction.
• EHR system design and user interface may have less impact on overall workflow patterns and workload than previously assumed.
• Further research is needed to understand the wide variability in physician activity and its relationship to workload for targeted EHR redesign and improved physician well-being.