Electronic Health Record Time Allocation Among Primary Care Clinicians at the Veterans Health Administration Using...

Area of Science:

• Health Services Research
• Clinical Informatics
• Primary Care Medicine

Background:

• Prior studies indicate primary care clinicians (PCPs) dedicate substantial time to electronic health record (EHR) tasks during patient visits.
• Limited data exists on EHR time allocation within the Veterans Health Administration (VHA) and specifically during virtual care modalities.
• Understanding EHR time is crucial for optimizing clinician workflow and patient care efficiency.

Purpose of the Study:

• To quantify the proportion of time PCPs spend interacting with the EHR during primary care encounters at VHA facilities.
• To compare EHR time allocation between in-person and virtual (phone, video) primary care visits.
• To assess the time PCPs spend on administrative EHR tasks between patient appointments.

Main Methods:

• A time-motion study was conducted using adapted software (WorkStudy+) for remote observation.
• Data was collected from 23 PCPs (physicians and nurse practitioners) across three VHA regional sites.
• Observed metrics included visit duration and the percentage of time spent on EHR tasks during and between visits.

Main Results:

• Across 211 observed visits, average durations were 23.9 min (in-person), 21.2 min (phone), and 29.3 min (video).
• EHR work constituted 35% of in-person visit time, 46% of phone visits, and 39% of video visits.
• Between visits, PCPs spent 54 minutes on administrative tasks per 4-hour session, primarily documentation (44%) and chart review (14%).

Conclusions:

• VHA PCPs allocate between 35% and 46% of patient visit time to EHR tasks, predominantly documentation and chart review.
• Virtual visits demand more EHR interaction time compared to in-person visits, suggesting reduced EHR use when patients are physically present.
• PCPs spend over two hours per half-day clinic session on EHR tasks, including administrative work performed between patients.