Measuring Primary Care Exam Length Using Electronic Health Record Data

Neprash, Hannah T.; Everhart, Alexander; McAlpine, Donna; Smith, Laura; Sheridan, Bethany; Cross, Dori A.

doi:10.1097/mlr.0000000000001450

Cited by 37 publications

(30 citation statements)

References 29 publications

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“… 11 Aims were not mutually exclusive so each study could have more than 1 aim. While all vendor-measure studies measured an amount of EHR use (e.g., volume or duration), 2–4 , 6 , 19 , 24–58 a third (33%) of investigator-measure studies did not, 60 , 68 , 74 , 78 , 80 , 82–87 , 89 , 91 , 92 , 98 , 102 , 109 , 112 , 115 focusing instead on the other 2 aims ( P < .001). Vendor-measure studies were more likely to characterize EHR or clinical workflows , such as when EHR activities were performed during the day (68% vs 43% of articles, P = .016), while investigator-measure studies were more likely to characterize team dynamics , for example, using record coaccess to determine which clinicians routinely worked together (23% vs 3% of studies, P = .004).…”

Section: Resultsmentioning

confidence: 99%

Using event logs to observe interactions with electronic health records: an updated scoping review shows increasing use of vendor-derived measures

Rule

Melnick

Apathy

2022

Journal of the American Medical Informatics Association

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Objective The aim of this article is to compare the aims, measures, methods, limitations, and scope of studies that employ vendor-derived and investigator-derived measures of electronic health record (EHR) use, and to assess measure consistency across studies. Materials and Methods We searched PubMed for articles published between July 2019 and December 2021 that employed measures of EHR use derived from EHR event logs. We coded the aims, measures, methods, limitations, and scope of each article and compared articles employing vendor-derived and investigator-derived measures. Results One hundred and two articles met inclusion criteria; 40 employed vendor-derived measures, 61 employed investigator-derived measures, and 1 employed both. Studies employing vendor-derived measures were more likely than those employing investigator-derived measures to observe EHR use only in ambulatory settings (83% vs 48%, P = .002) and only by physicians or advanced practice providers (100% vs 54% of studies, P < .001). Studies employing vendor-derived measures were also more likely to measure durations of EHR use (P < .001 for 6 different activities), but definitions of measures such as time outside scheduled hours varied widely. Eight articles reported measure validation. The reported limitations of vendor-derived measures included measure transparency and availability for certain clinical settings and roles. Discussion Vendor-derived measures are increasingly used to study EHR use, but only by certain clinical roles. Although poorly validated and variously defined, both vendor- and investigator-derived measures of EHR time are widely reported. Conclusion The number of studies using event logs to observe EHR use continues to grow, but with inconsistent measure definitions and significant differences between studies that employ vendor-derived and investigator-derived measures.

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Section: Resultsmentioning

confidence: 99%

Using event logs to observe interactions with electronic health records: an updated scoping review shows increasing use of vendor-derived measures

Rule

Melnick

Apathy

2022

Journal of the American Medical Informatics Association

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“…This visit length in the model was associated with reported mean visit lengths in actual practice, suggesting that time-based billing has limited implications for many clinics. 15,18,23 The highest E/M revenues in this study were associated with a combination of short patient visits and MDM-based billing. This finding demonstrates that time-based billing is unlikely to change financial incentives given for shorter visits.…”

Section: Discussionmentioning

confidence: 72%

Association of Time-Based Billing With Evaluation and Management Revenue for Outpatient Visits

et al. 2022

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IMPORTANCE Time-based billing options for physicians have expanded, enabling many physicians to bill according to time spent instead of medical decision-making (MDM) level for fee-for-service outpatient visits. However, no study to date has estimated the revenue changes associated with timebased billing. OBJECTIVE To compare evaluation and management (E/M) reimbursement for physicians using time-based billing vs MDM-based billing for outpatient visits of varying lengths. DESIGN, SETTING, AND PARTICIPANTS This economic evaluation used 2019 billing data for outpatient E/M codes and 2021 reimbursement rates from the Centers for Medicare & Medicaid Services. Modeling of generic clinic templates was performed to estimate expected yearly E/M revenues for a single full-time physician working in an outpatient clinic using fee-for-service billing. MAIN OUTCOMES AND MEASURES Yearly E/M revenues for different patient visit templates were modeled. The standardized length of return patient visits was 10 to 45 minutes, and new patient visits were twice as long in duration. RESULTS Under MDM-based billing, increased visit length was associated with decreased E/M revenue

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“…Empirical evidence also suggests that EHR usability is a key determinant of patient outcomes whereas employing EHR systems with less perceived usefulness is related to less EHR adoption. 34 …”

Section: Discussionmentioning

confidence: 99%

Frequent and diverse use of electronic health records in the United States: A trend analysis of national surveys

Zheng

Jiang

2022

DIGITAL HEALTH

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Objective Considering the increasing integration of electronic health records (EHRs) into medical practice by healthcare organizations, it is especially pertinent to understand its actual usage by the general public in recent years. This study aims to explore factors associated with the frequency and diversity of EHR usage in the United States over time. Methods We analyzed three iterations (2017, 2018, and 2019) of the Health Information National Trends Survey (HINTS). HINTS is a national cross-sectional survey conducted by the National Cancer Institute to document attitudes and perceptions about health information access and use among American adults. Results Both frequency and diversity of EHR usage have slightly increased across the years. However, its overall usage still remained low. Three technology-related enablers (access to digital devices, access to the Internet, and perceived usefulness of EHRs) were positively related to EHR usage in all three iterations. In addition, perceived health status was a constant and negative predictor of EHR usage over years. Doctor–patient communication was positively associated with the frequency of EHR usage in two survey waves. Conclusions More initiatives to increase EHR usage in the United States are needed. We advocate for providing affordable Internet access and smartphone to underserved populations; in medical encounters, doctors should have more patient-centered communication, introduce the benefits of EHRs to patients, and promote EHR adoption in terms of frequency and diversity.

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Measuring Primary Care Exam Length Using Electronic Health Record Data

Cited by 37 publications

References 29 publications

Using event logs to observe interactions with electronic health records: an updated scoping review shows increasing use of vendor-derived measures

Using event logs to observe interactions with electronic health records: an updated scoping review shows increasing use of vendor-derived measures

Association of Time-Based Billing With Evaluation and Management Revenue for Outpatient Visits

Frequent and diverse use of electronic health records in the United States: A trend analysis of national surveys

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