Bae Jaeyong, Encinosa William E
School of Nursing and Health Studies, Northern Illinois University, Wirtz Hall 257, Dekalb, IL, 60115, USA.
Center for Delivery, Organization and Markets, Agency for Healthcare Research and Quality, 5600 Fishers Ln, Rockville, MD, 20857, USA.
BMC Health Serv Res. 2016 May 10;16:172. doi: 10.1186/s12913-016-1422-6.
Eighty-four thousand primary care physicians have received $1.3 billion in HITECH payments for EHR adoption. However, little is known about how this will impact primary care workload efficiency and the national primary care shortage. This study examines whether EHR is associated with increases in face time with the patient per visit and increases in the physician's patient volume per week.
We used a nationally representative sample of 37,962 patient visits to 1470 primary care physicians during the pre-HITECH years 2006-2009 from the restricted-access version of the National Ambulatory Medical Care Survey. Quantile regressions were used to estimate the effects of EHR use on patient face time per visit and physician's patient volume per week at different points of the time and volume distributions.
Primary care physicians with EHR spend an extra 1.3 face time minutes per visit, or 1.5 extra hours per week. This is 34,000 extra hours of face time per week in the U.S. However, physician age matters. Among young physicians, EHR use is associated with a decline in weekly patient volume, while EHR use among older physicians is associated with an increase in volume, regardless of initial practice size. If younger physicians behaved like older physicians when adopting EHR, there would be 37,600 additional patient visits per week in the U.S., the equivalent of adding 500 more primary care physicians to the U.S. workforce.
EHR can enhance productivity/efficiency in primary care physician workloads.
8.4万名初级保健医生因采用电子健康记录（EHR）获得了13亿美元的《健康信息技术经济与临床健康法案》（HITECH）付款。然而，对于这将如何影响初级保健工作量效率和全国初级保健医生短缺情况，人们知之甚少。本研究考察了电子健康记录是否与每次就诊时与患者面对面交流时间的增加以及医生每周患者接待量的增加相关。
我们使用了2006 - 2009年HITECH法案实施前几年全国门诊医疗护理调查受限访问版本中，1470名初级保健医生的37962次患者就诊的全国代表性样本。分位数回归用于估计在时间和量分布的不同点，使用电子健康记录对每次就诊患者面对面交流时间和医生每周患者接待量的影响。
使用电子健康记录的初级保健医生每次就诊额外花费1.3分钟面对面交流时间，即每周额外增加1.5小时。这相当于美国每周有34000小时的额外面对面交流时间。然而，医生年龄很重要。在年轻医生中，使用电子健康记录与每周患者接待量下降相关，而在年长医生中，无论初始执业规模如何，使用电子健康记录都与接待量增加相关。如果年轻医生在采用电子健康记录时表现得像年长医生一样，那么美国每周将额外增加37600次患者就诊，相当于美国劳动力中增加500多名初级保健医生。
电子健康记录可以提高初级保健医生工作量的生产力/效率。
