Howard J, Clark EC, Friedman A, et al. "Electronic health record impact on work burden in small, unaffiliated, community-based primary care practices."
Reference
Howard J, Clark EC, Friedman A, et al. Electronic health record impact on work burden in small, unaffiliated, community-based primary care practices. J Gen Intern Med 2013 Jan;28(1):107-13.
Abstract
BACKGROUND: The use of electronic health records (EHR) is widely recommended as a means to improve the quality, safety and efficiency of US healthcare. Relatively little is known, however, about how implementation and use of this technology affects the work of clinicians and support staff who provide primary health care in small, independent practices. OBJECTIVE: To study the impact of EHR use on clinician and staff work burden in small, community-based primary care practices. DESIGN: We conducted in-depth field research in seven community-based primary care practices. A team of field researchers spent 9-14 days over a 4-8 week period observing work in each practice, following patients through the practices, conducting interviews with key informants, and collecting documents and photographs. Field research data were coded and analyzed by a multidisciplinary research team, using a grounded theory approach. PARTICIPANTS: All practice members and selected patients in seven community-based primary care practices in the Northeastern US. KEY RESULTS: The impact of EHR use on work burden differed for clinicians compared to support staff. EHR use reduced both clerical and clinical staff work burden by improving how they check in and room patients, how they chart their work, and how they communicate with both patients and providers. In contrast, EHR use reduced some clinician work (i.e., prescribing, some lab-related tasks, and communication within the office), while increasing other work (i.e., charting, chronic disease and preventive care tasks, and some lab-related tasks). Thoughtful implementation and strategic workflow redesign can mitigate the disproportionate EHR-related work burden for clinicians, as well as facilitate population-based care. CONCLUSIONS: The complex needs of the primary care clinician should be understood and considered as the next iteration of EHR systems are developed and implemented.
Objective
To study the impact of EHR use on clinician and staff work burden in small, community-based primary care practices.
Tools Used
Type Clinic
Primary care
Size
Small and/or medium
Other Information
Seven physician-owned, single specialty primary care practices in the Northeastern US.
Type of Health IT
Electronic health records (EHR)
Type of Health IT Functions
Limited information about functions of EHR. All 7 practices had e-prescribing, however, 2 of the practices' e-prescribing software was a separate software and not part of the EHR.
Context or other IT in place
All practices have EHR in place with varying time of implementation and all had e-prescribing software.
Workflow-Related Findings
The impact of EHR use on work burden differed for clinicians compared to support staff. EHR use reduced both clerical and clinical staff work burden
by improving how they check in and room patients, how they chart their work, and how they communicate with both patients and providers. In contrast, EHR use reduced some clinician work (i.e., prescribing, some lab-related tasks, and communication within the office), while increasing other work (i.e., charting, chronic disease and preventive care tasks, and some lab-related
tasks). Thoughtful implementation and strategic workflow redesign can mitigate the disproportionate EHR related work burden for clinicians, as well as facilitate population-based care.
by improving how they check in and room patients, how they chart their work, and how they communicate with both patients and providers. In contrast, EHR use reduced some clinician work (i.e., prescribing, some lab-related tasks, and communication within the office), while increasing other work (i.e., charting, chronic disease and preventive care tasks, and some lab-related
tasks). Thoughtful implementation and strategic workflow redesign can mitigate the disproportionate EHR related work burden for clinicians, as well as facilitate population-based care.
For practices that had invested efforts into thinking through office workflow and work roles to optimally support the clinical process, the EHR offered a different experience. Expanding the MA role meant that clinicians had less documentation and were afforded more time to do it. In Practice 6, the MA role was expanded to include a variety of panel management of chronic disease and preventive health tasks that had previously been performed by clinicians. The MA followed clear protocols to complete tasks such as populating preventive flow sheets, tracking lab results, addressing patient requests (e.g., protocol-driven lab orders and referrals), managing patient registries, contacting patients for preventive and chronic care follow-ups, and, in some cases, documenting an initial patient history at the beginning of a patient visit. While these tasks created more work for the MA, the increased responsibilities and the title of “panel manager” were a source of pride and job satisfaction.
Study Design
Only postintervention (no control group)
Study Participants
Staff and providers at practices (number undefined) were interviewed. Patients were followed from beginning to end of their visits in a series of "patient pathways" to identify how EHR use was incorporated into the visit.