Between-Visit Workload in Primary Care

Doerr, Emmett; Galpin, Kevin; Jones-Taylor, Cedrella; Anander, Steven; Demosthenes, Charles; Platt, Susan; Ponkshe, Sanjay

doi:10.1007/s11606-010-1470-2

Cited by 30 publications

(23 citation statements)

References 9 publications

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“…[1][2][3] In addition to physician reports of their own efforts, 2,4,5 researchers have used time-andmotion studies 6 and video 7 and audio recordings. 8 While these methods capture significant physician effort, 6,[9][10][11] they are costly to use and often evaluate only a limited number of physicians. Even the resource-based relative values scale (RBRVS) was built, for some specialties, on survey responses to vignettes from about twenty physicians.…”

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confidence: 99%

Electronic Health Record Logs Indicate That Physicians Split Time Evenly Between Seeing Patients And Desktop Medicine

Tai-Seale¹,

et al. 2017

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Time spent by physicians is a key resource in health care delivery. This study used data captured by the access time stamp functionality of an electronic health record (EHR) to examine physician work effort. This is a potentially powerful, yet unobtrusive, way to study physicians' use of time. We used data on physicians' time allocation patterns captured by over thirty-one million EHR transactions in the period 2011-14 recorded by 471 primary care physicians, who collectively worked on 765,129 patients' EHRs. Our results suggest that the physicians logged an average of 3.08 hours on office visits and 3.17 hours on desktop medicine each day. Desktop medicine consists of activities such as communicating with patients through a secure patient portal, responding to patients' online requests for prescription refills or medical advice, ordering tests, sending staff messages, and reviewing test results. Over time, log records from physicians showed a decline in the time allocated to face-to-face visits, accompanied by an increase in time allocated HHS Public AccessAuthor manuscript Health Aff (Millwood). Author manuscript; available in PMC 2017 August 07. Author Manuscript Author ManuscriptAuthor Manuscript Author Manuscript to desktop medicine. Staffing and scheduling in the physician's office, as well as provider payment models for primary care practice, should account for these desktop medicine efforts.Physician time is a key resource in health services delivery. Understanding how physicians spend their clinical time is essential, given the need to understand practical capacity; guide staffing, scheduling, and support models in the physician's office; and improve the accuracy of payment for physician services. Fee-for-service payments are intended to reflect resources (captured as relative value units, or RVUs) used before, during, and after clinical encounters associated with face-to-face ambulatory care visits. 1-3 Questions have been raised about whether the reports underlying the RVU estimates are accurate and representative of true physician effort in providing patient care services. In the age of electronic health records (EHRs) with patient portals, patients often request services (such as prescription refills and medical advice) online, without face-to-face visits. Physician effort in addressing these online requests was absent from the original RVU calculations. [1][2][3] In addition to physician reports of their own efforts, 2,4,5 researchers have used time-andmotion studies 6 and video 7 and audio recordings. 8 While these methods capture significant physician effort, 6,9-11 they are costly to use and often evaluate only a limited number of physicians. Even the resource-based relative values scale (RBRVS) was built, for some specialties, on survey responses to vignettes from about twenty physicians. 1 This scale is still the chief tool used to determine the periodic updates to the Medicare Fee Schedule. Furthermore, concerns about the Hawthorne effect preclude ongoing, broad-based direct observa...

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confidence: 99%

Electronic Health Record Logs Indicate That Physicians Split Time Evenly Between Seeing Patients And Desktop Medicine

Tai-Seale¹,

et al. 2017

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“…A time allocation study conducted in VHA prior to PACT implementation determined that primary care providers averaged 8.6 h per week on patient care work outside of office visits. 18 In a context of limited time, providers struggle to manage the additional workload 19 and to prioritize direct patient care work over panel management activities. 20 Underutilized intra-team delegation is a related component of time limitations, 21 but a sense of obligation may reduce primary are providers' willingness and ability to share work with teammates.…”

Section: Discussionmentioning

confidence: 99%

Implementing a patient centered medical home in the Veterans health administration: Perspectives of primary care providers

Solimeo

Stewart

et al. 2014

Healthcare

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“…In fact, synergistic effects imposed by combinations of key comorbid conditions have been guardedly observed by researchers for select health outcomes (Conwell & Boult, 2008;Kerr et al, 2007;Wee et al, 2005). Some scholars have hypothesized that such complex mechanisms may be more pronounced for adults with higher levels of comorbidity because of their increased number of physical or self-management demands (Baldwin et al, 2006;Charlson et al, 2007;Extermann, 2007;Fortin, Dionne et al, 2006).…”

Section: Background and Significancementioning

confidence: 99%

Increasing Primary Care Comorbidity: A Conceptual Research and Practice Framework

Corser

2011

Res Theory Nurs Pract

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Conceptual implications are discussed for primary care researchers testing interventions and attempting to influence the outcomes of increasingly comorbid primary care adults. Implications for Nursing Research and Practice: Three strategies are offered for researchers and clinicians considering how to include elements of comorbidity into their prospective primary care study interventions and care delivery processes.

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Between-Visit Workload in Primary Care

Abstract: Primary internists spent a median of 7.9 h per week in work between office visits with 82% of the time involved in changes in management.

Cited by 30 publications

References 9 publications

Electronic Health Record Logs Indicate That Physicians Split Time Evenly Between Seeing Patients And Desktop Medicine

Electronic Health Record Logs Indicate That Physicians Split Time Evenly Between Seeing Patients And Desktop Medicine

Implementing a patient centered medical home in the Veterans health administration: Perspectives of primary care providers

Increasing Primary Care Comorbidity: A Conceptual Research and Practice Framework

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