System-Level Factors and Time Spent on Electronic Health Records by Primary Care Physicians

Area of Science:

• Health Services Research
• Medical Informatics
• Primary Care Medicine

Background:

• Primary care physicians (PCPs) dedicate substantial time to electronic health records (EHRs), impacting workflow and efficiency.
• Understanding the factors influencing EHR time is crucial for optimizing primary care delivery and physician well-being.

Purpose of the Study:

• To quantify the variation in EHR time among PCPs and across different primary care clinics.
• To identify specific physician, patient panel, clinic, and team collaboration factors associated with PCPs' EHR time.

Main Methods:

• A cross-sectional study involving 307 PCPs across 31 primary care clinics.
• Analysis of EHR activity log data to measure total per-visit EHR time, 'pajama time' (off-hours EHR use), and electronic inbox time.
• Multivariable modeling to assess associations between various factors and EHR time expenditure.

Main Results:

• PCPs spent a median of 36.2 minutes per visit on EHRs, including 6.2 minutes of 'pajama time' and 7.8 minutes on the electronic inbox.
• Significant variation in EHR time was observed between clinics, with total EHR time per visit ranging from 23.5 to 47.9 minutes.
• Higher teamwork on orders (3.81 fewer minutes/visit) and the presence of a clinic pharmacy technician (7.87 fewer minutes/visit) were associated with reduced EHR time. Practicing in a community health center was also linked to less EHR time (5.40 fewer minutes/visit).

Conclusions:

• Substantial variability exists in EHR time among PCPs and clinics, indicating opportunities for optimization.
• Organizational factors, including team collaboration, pharmacy technician support, and community health center settings, are linked to decreased EHR burden.
• Addressing EHR time demands requires a systems-level approach, focusing on improving clinic workflows and support structures.