Deeds Stefanie A, Hagan Scott L, Kath Sara E, Taylor Leslie L, Reddy Ashok S, Nelson Karin M
VA Puget Sound Health Care System, Seattle, WA, USA.
Division of General Internal Medicine, University of Washington, Seattle, WA, USA.
J Gen Intern Med. 2025 Jan 6. doi: 10.1007/s11606-024-09328-y.
Prior research has shown that primary care clinicians (PCPs) spend a large portion of clinic visits on tasks within the electronic health record (EHR). However, no time allocation studies have been done in the Veterans Health Administration (VHA) and little is known about EHR time spent during virtual visits.
To estimate the proportion of clinician time spent working within the EHR during primary care visits at VHA clinics.
We used a time study software (WorkStudy+) adapted from prior research to collect time-motion data via remote observation of in-person and virtual visits.
23 PCPs (including physicians and nurse practitioners) from 3 regional VA sites.
Proportion of observed time spent interfacing with the EHR during a primary care visit.
Of 211 primary care visits observed, the average visit length was 23.9 min in-person, 21.2 min by phone, and 29.3 min on video. The percentage of time spent on EHR work during the visit was 35% for in-person visits, 46% for phone visits, and 39% for video visits. During n=39 4-h clinic sessions, PCPs spent 54 min completing administrative tasks between patient visits, with 44% of time spent on documentation, 14% on chart review, and 14% on placing orders.
PCPs at the VHA spend between one-third and one-half of each patient visit interfacing with the EHR. Most of this time is spent on documentation and chart review. Less time was spent in the EHR during in-person visits compared to virtual visits, suggesting that clinicians limit EHR task completion when the patient is present. Between patient visits during clinic sessions, PCPs spend 75% of their time working in the EHR. In total, this represents over 2 h per half-day clinic session spent on EHR tasks.
先前的研究表明，基层医疗临床医生（PCP）在门诊就诊时将很大一部分时间花在电子健康记录（EHR）相关任务上。然而，退伍军人健康管理局（VHA）尚未开展过时间分配研究，对于虚拟就诊期间花在EHR上的时间了解甚少。
估计VHA诊所基层医疗就诊期间临床医生花在EHR工作上的时间比例。
我们使用了一款根据先前研究改编的时间研究软件（WorkStudy+），通过对面对面就诊和虚拟就诊的远程观察来收集时间动作数据。
来自3个地区退伍军人管理局站点的23名基层医疗临床医生（包括医生和执业护士）。
基层医疗就诊期间观察到的与EHR交互所花费时间的比例。
在观察的211次基层医疗就诊中，面对面就诊的平均时长为23.9分钟，电话就诊为21.2分钟，视频就诊为29.3分钟。就诊期间花在EHR工作上的时间百分比，面对面就诊为35%，电话就诊为46%，视频就诊为39%。在n = 39次4小时的门诊时段中，基层医疗临床医生在患者就诊间隙花54分钟完成行政任务，其中44%的时间用于记录，14%用于病历审查，14%用于下医嘱。
VHA的基层医疗临床医生在每次患者就诊时，花三分之一到一半的时间与EHR交互。这段时间大部分用于记录和病历审查。与虚拟就诊相比，面对面就诊期间花在EHR上的时间较少，这表明临床医生在患者在场时会限制EHR任务的完成。在门诊时段的患者就诊间隙，基层医疗临床医生花75%的时间在EHR上工作。总体而言，这意味着每个半天的门诊时段花在EHR任务上的时间超过2小时。
