Assessing the Effects of EHR Optimization Interventions in Primary Care

Primary care in the United States is facing a crisis due to increasing physician burnout, which undermines workforce sustainability, access to care, and quality of care. A major contributor to this burnout is the EHR, which demands significant time and effort from primary care physicians (PCPs). Fifteen years after the HITECH Act drove widespread EHR adoption, health systems are grappling with a critical dilemma: balancing the benefits of EHRs for patient safety and quality with the significant burdens they place on PCPs. Among all specialties, PCPs spend the most time on EHR tasks—both during and after work hours—while managing the highest volume of EHR-based messages, contributing to burnout and workforce turnover. While interventions such as scribes, advanced team-based inbox management, and artificial intelligence (AI)-assisted messaging support show promise in optimizing EHR use and reducing physician burden, evidence on their effectiveness is limited. Further, there is limited understanding of how these interventions impact physician wellbeing, patient care quality, and healthcare costs. Research is urgently needed to evaluate these strategies comprehensively, guide health systems in their implementation, and address the goals of enhancing primary care quality and improving PCP satisfaction and sustainability.

The specific aims of the research are as follows:

• Test for associations between use of three EHR-optimization interventions, individually or in combination, with PCPs’ EHR time and wellbeing, patient-panel level quality of care, and utilization of care.
• Describe PCP and team member experiences of adopting the three EHR-optimization interventions and the mechanisms by which the interventions are associated with EHR time, physician wellbeing, and quality and utilization of care.
• Quantify the costs to health systems of implementing each of the three EHR-optimization interventions, either individually or in combination.

The research uses a multi-method approach using longitudinal data from multiple health systems to examine the impact of EHR-optimization strategies on key outcomes. Semi-structured interviews with stakeholders will explore factors driving adoption, de-adoption, and implementation success, and operational data will be used to evaluate the costs of these strategies and assess their cost-effectiveness.

This research aims to provide healthcare leaders with actionable insights to address EHR-related challenges and optimize its use. By linking EHR-optimization interventions to physician workload, patient care quality, and economic considerations, the study may empower leaders to implement cost-effective strategies with maximal potential for improving PCP satisfaction, enhancing quality of care, and reducing healthcare costs. The findings will inform healthcare policy and practice through development of rigorous evidence and robust dissemination activities. By advancing sustainable solutions to reduce physician burnout and improve patient outcomes, study findings have the potential to shape future research and implementation efforts.