Development of a primary care physician task list to evaluate clinic visit workflow: Table 1

Abstract

Background Interventions designed to improve the delivery of primary care, including Patient-Centered Medical Homes and electronic health records, require an understanding of clinical workflow to be successfully implemented. However, there is a lack of tools to describe and study primary care physician workflow. We developed a comprehensive list of primary care physician tasks that occur during a face-to-face patient visit. Methods A validated list of tasks performed by primary care physicians during patient clinic visits was developed from a secondary data analysis of observation data from two studies evaluating primary care workflow. Thirty primary care physicians participated from a convenience sample of 17 internal medicine and family medicine clinics in Wisconsin and Iowa across rural and urban settings and community and academic settings. Results The final task list has 12 major tasks, 189 subtasks, and 191 total tasks. The major tasks are: Enter Room, Gather Information from Patient, Review Patient Information, Document Patient Information, Perform, Recommend / Discuss Treatment Options, Look Up, Order, Communicate, Print / Give Patient (advice, instructions), Appointment Wrap-up, and Leave Room. Additional subcodes note use of paper or EHR and the presence of a caregiver or medical student. Conclusions The task list presented here is a tool that will help clinics study their workflows so they can plan for changes that will take place because of EHR implementation and/or transformation to a patient centered medical home.

Approaches and challenges to optimising primary care teams' electronic health record usage

“…The implementation of EHRs has generally been done in the absence of an in-depth understanding of the workflow, cognitive, and interactional activities in primary care, 5 much less the support needed to accomplish these tasks. 41 The tasks in primary care have been enumerated, 42 but have not been incorporated into EHR design. 6 Training may be able to make up for poor design or implementation goals, but only to a point.…”

Using tablets in medical consultations: Single loop and double loop learning processes

“…The patient-doctor encounter is a complex, dynamic interaction. The visit workflow e a process that includes booking an appointment, seeing the doctor, and following up e is filled with obstacles and opportunities that may impede or improve patients and providers' satisfaction (Wetterneck et al 2012).…”

Quantitative ethnographic study of physician workflow and interactions with electronic health record systems

“…There are compelling reasons to use electronic health records (EHR) in healthcare due to its potential to improve quality and efficiency in healthcare (Chaudhry et al, 2006; Mitchell and Sullivan, 2001). However, it is important to consider how this health IT may impact clinical work and healthcare outcomes (Wetterneck et al, 2011). 1.2.…”

“…Using data from two observational studies of primary care work in the US, Wetterneck and colleagues (2011) developed a comprehensive list of tasks primary care physicians complete during face-to-face patient visits (Wetterneck et al, 2011). The sequence in which tasks might be performed, and the types of tasks performed were included in this list.…”

“…Coding has been used in prior observational research in human factors (Zandbelt et al, 2005). In this study, a validated list of workflow tasks performed by primary care physicians during patient clinic visits (Wetterneck et al, 2011) were used as unit measures in the coding scheme. Two coders coded each video capturing a primary care visit according to the tasks that occurred.…”