Skip to main content

Main menu

  • Home
  • Current Issue
  • Content
    • Current Issue
    • Early Access
    • Multimedia
    • Podcast
    • Collections
    • Past Issues
    • Articles by Subject
    • Articles by Type
    • Supplements
    • Plain Language Summaries
    • Calls for Papers
  • Info for
    • Authors
    • Reviewers
    • Job Seekers
    • Media
  • About
    • Annals of Family Medicine
    • Editorial Staff & Boards
    • Sponsoring Organizations
    • Copyrights & Permissions
    • Announcements
  • Engage
    • Engage
    • e-Letters (Comments)
    • Subscribe
    • Podcast
    • E-mail Alerts
    • Journal Club
    • RSS
    • Annals Forum (Archive)
  • Contact
    • Contact Us
  • Careers

User menu

  • My alerts

Search

  • Advanced search
Annals of Family Medicine
  • My alerts
Annals of Family Medicine

Advanced Search

  • Home
  • Current Issue
  • Content
    • Current Issue
    • Early Access
    • Multimedia
    • Podcast
    • Collections
    • Past Issues
    • Articles by Subject
    • Articles by Type
    • Supplements
    • Plain Language Summaries
    • Calls for Papers
  • Info for
    • Authors
    • Reviewers
    • Job Seekers
    • Media
  • About
    • Annals of Family Medicine
    • Editorial Staff & Boards
    • Sponsoring Organizations
    • Copyrights & Permissions
    • Announcements
  • Engage
    • Engage
    • e-Letters (Comments)
    • Subscribe
    • Podcast
    • E-mail Alerts
    • Journal Club
    • RSS
    • Annals Forum (Archive)
  • Contact
    • Contact Us
  • Careers
  • Follow annalsfm on Twitter
  • Visit annalsfm on Facebook
Research ArticleOriginal ResearchA

Tethered to the EHR: Primary Care Physician Workload Assessment Using EHR Event Log Data and Time-Motion Observations

Brian G. Arndt, John W. Beasley, Michelle D. Watkinson, Jonathan L. Temte, Wen-Jan Tuan, Christine A. Sinsky and Valerie J. Gilchrist
The Annals of Family Medicine September 2017, 15 (5) 419-426; DOI: https://doi.org/10.1370/afm.2121
Brian G. Arndt
1School of Medicine and Public Health, Department of Family Medicine and Community Health, University of Wisconsin, Madison, Wisconsin
MD
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • For correspondence: brian.arndt@fammed.wisc.edu
John W. Beasley
1School of Medicine and Public Health, Department of Family Medicine and Community Health, University of Wisconsin, Madison, Wisconsin
2University of Wisconsin College of Engineering, Department of Industrial and Systems Engineering, Madison, Wisconsin
MD
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Michelle D. Watkinson
1School of Medicine and Public Health, Department of Family Medicine and Community Health, University of Wisconsin, Madison, Wisconsin
MPH
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Jonathan L. Temte
1School of Medicine and Public Health, Department of Family Medicine and Community Health, University of Wisconsin, Madison, Wisconsin
MD, PhD
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Wen-Jan Tuan
1School of Medicine and Public Health, Department of Family Medicine and Community Health, University of Wisconsin, Madison, Wisconsin
MS, MPH
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Christine A. Sinsky
3American Medical Association, Chicago, Illinois
MD
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Valerie J. Gilchrist
1School of Medicine and Public Health, Department of Family Medicine and Community Health, University of Wisconsin, Madison, Wisconsin
MD
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • Article
  • Figures & Data
  • eLetters
  • Info & Metrics
  • PDF
Loading

Article Figures & Data

Figures

  • Tables
  • Additional Files
  • Figure 1
    • Download figure
    • Open in new tab
    • Download powerpoint
    Figure 1

    Screenshot of WorkStudy+ application for the iPad.

    Note: For direct observation, we developed 15 electronic health record (EHR) task categories plus several non-EHR task categories (eg, staff interactions, e-mail, paperwork and other administrative work, and personal time). Some of the categories shown have further subcategories that appear once the category is selected.

  • Figure 2
    • Download figure
    • Open in new tab
    • Download powerpoint
    Figure 2

    Family physicians’ EHR use by time of day.

    EHR=electronic health record.

Tables

  • Figures
  • Additional Files
    • View popup
    Table 1

    Classifying User-Event Log Data Into 15 EHR Task Categories

    EHR Task CategoryExamples
    Clerical
     AdministrativeAccessing patient demographics for telephone number before calling patient
     Billing and CodingAssigning CPT and ICD-10 codes to encounter diagnosis/diagnoses
     DocumentationTyping into a progress note within any encounter type
     Order EntryPlacing an order for a medication, laboratory test, consultation or referral, durable medical equipment, others
     System SecurityLogging in, logging out, secondary login to review psychiatric records
    Medical care
     Chart Review-ImagingReviewing findings of a chest radiograph
     Chart Review-LaboratoriesReviewing cholesterol test results
     Chart Review-MedicationsReviewing medication list
     Chart Review-NotesReviewing an encounter note from office visit, urgent care, emergency department
     EBM, Point of CareAccessing an evidence-based resource available through an EHR link, such as UpToDate
     Problem ListReviewing or editing the active problem list
    Inbox
     Refills and Results ManagementRefilling medications; interpreting new laboratory and imaging results
     Letter GenerationDeveloping a letter to patient
     MyChart PortalResponding to a patient’s question about a medication through asynchronous e-mail–type dialog
     Telephone CallAddressing an incoming telephone call or generating an outgoing telephone call encounter
    • CPT= Current Procedural Terminology; EBM = evidence-based medicine; EHR = electronic health record; ICD-10 = International Classification of Diseases, 10th Revision.

    • View popup
    Table 2

    Characteristics of Family Medicine Physicians

    CharacteristicPhysicians, No. (%) (N=142)
    Clinic type
     Community76 (53.5)
     Residency44 (31.0)
     Regional22 (15.5)
    Sex
     Female80 (56.3)
     Male62 (43.7)
    Years of practice
     ≤933 (23.2)
     10–1947 (33.2)
     20–2931 (21.8)
     ≥3031 (21.8)
    Clinical FTEs
     0.90–1.0040 (28.2)
     0.75–0.8922 (15.5)
     0.50–0.7433 (23.2)
     <0.5047 (33.1)
    • FTE=full-time equivalent.

    • View popup
    Table 3

    Average Time Spent Per Day by EHR Task Category, Comparing Work Hours and After Hours

    EHR Task CategoryTime Spent per Day, minTotal Time Spent per Day, min (% of Daily Total)
    Work HoursAfter HoursRatio
    Clerical
     Documentation64203.284 (23.7)
     Order Entry3584.443 (12.1)
     Billing and Coding1042.514 (3.9)
     System Security824.010 (2.8)
     Administrative422.06 (1.7)
     Subtotal121363.4157 (44.2)
    Medical care
     Chart Review – Notes47133.660 (16.9)
     Chart Review – Medications2154.226 (7.3)
     Problem List842.012 (3.4)
     Chart Review – Laboratories632.09 (2.5)
     EBM, Point of Care22104 (1.1)
     Chart Review – Imaging212.03 (0.8)
     Subtotal86283.1114 (32.1)
    Inbox
     Refills and Results41142.955 (15.5)
     Management
     MyChart Portal1553.020 (5.6)
     Telephone Call522.57 (2.0)
     Letter Generation111.02 (0.6)
     Subtotal62222.884 (23.7)
    Total269863.1355 (100.0)
    • EBM=evidence-based medicine; EHR=electronic health record.

Additional Files

  • Figures
  • Tables
  • The Article in Brief

    Tethered to the EHR: Primary Care Physician Workload Assessment Using EHR Event Log Data and Time-Motion Observations

    Brian G. Arndt , and colleagues

    Background US physicians spend numerous hours each day interacting with electronic health record (EHR) systems, which in turn contributes to work life imbalance, dissatisfaction, high rates of attrition, and burnout. This study assessed primary care physician time and usage patterns interacting with the EHR.

    What This Study Found Primary care physicians spent more than one-half of their workday interacting with the electronic health record during and after clinic hours. Research based on data from EHR event logs (an automated tracking feature) and confirmed by direct observation data found that physicians spent 355 minutes (5.9 hours) of an 11.4 hour workday in the EHR, including 269 minutes (4.5 hours) during clinic hours and 86 minutes (1.4 hours) after hours. Almost half of their total EHR time per day (44 percent) was devoted to clerical tasks and an additional 84 minutes per day (24 percent) was spent managing the inbox. Time spent on EHR activities differed by time of day on weekdays and weekends, with weekend EHR work peaking around 10:00 am and 10:00 pm. A number of factors contribute to physician burnout and increased workload related to the EHR, the authors explain. This includes the amount of time required for documentation (84 minutes) and order entry (43 minutes), as well as the inefficiency and distraction of communicating with team members through the EHR instead of verbally.

    Implications

    • The authors contend that solutions for common problems in primary care, such as proactive planned care, team-based care, and sharing of clerical tasks, require thoughtful EHR system applications.
  • Annals Journal Club

    Sep/Oct 2017: Tethered to the EHR: A Physician Workload Assessment


    The Annals of Family Medicine encourages readers to develop a learning community to improve health care and health through enhanced primary care. Participate by conducting a RADICAL journal club. RADICAL stands for Read, Ask, Discuss, Inquire, Collaborate, Act, and Learn. We encourage diverse participants to thinking critically about important issues affecting primary care and act on those discussions.1

    HOW IT WORKS

    In each issue, the Annals selects an article and provides discussion tips and questions. Take a RADICAL approach to these materials and post a summary of your conversation in our online discussion. (Open the article online and click on "TRACK Discussion/ Submit a comment.") Discussion questions and information are online at: http://www.AnnFamMed.org/site/AJC/.

    The Annals Twitter Journal Club (#AJC), featuring a discussion of this article, will be held on Wednesday October 4 at 12:00 pm EDT / 16:00 pm GMT.

    CURRENT SELECTION

    Article for Discussion

    Arndt BG, Beasley JW, Watkinson MD, et al. Tethered to the EHR: primary care physician workload assessment using EHR event log data and time-motion observations. Ann Fam Med 2017;15(5):419-426.

    Discussion Tips

    With advancements in medicine have come an increased demand for non-face-to-face patient care and administrative tasks for primary care physicians. This study retrospectively assessed how many hours primary care physicians dedicate to their work, with a focus on increased time spent on electronic health records (EHR). The article provides an opportunity to discuss expectations of physicians and the direct effects on physician burnout, professional satisfaction, and direct patient care.

    Discussion Questions

    • What question is asked by this study and why does it matter?
    • How does this study advance beyond previous research on this topic?
    • How strong is the study design for answering the question?
    • What are the main study findings?
    • To what degree can the findings be accounted for by:
      • How physicians were selected for the study?
      • The type of practice of the physicians in the study?
      • How the main variables were measured?
      • How the findings were interpreted?
    • How comparable is the study sample to physicians in your practice? What is your judgment about the transportability of the findings?
    • What contextual factors are important for interpreting the findings?
    • How might this study change your practice? Policy? Education? Research? System level intervention?
    • Who are the constituencies for the findings, and how might they be engaged in interpreting or using the findings?
    • What are the implications for:
      • Design of the EHR
      • Staffing of family medicine offices (see the article by Gidwani et al in this issue, on the use of scribes)2
      • Scheduling patients
      • The future of family medicine?
    • What researchable questions remain?

    References

    1. Stange KC, Miller WL, McLellan LA, et al. Annals Journal Club: It's time to get RADICAL. Ann Fam Med. 2006;4(3):196-197 http://annfammed.org/content/4/3/196.full.
    2. Gidwani R, Nguyen C, Kofoed A, et al. Impact of scribes on physician satisfaction, patient satisfaction, and charting efficiency: a randomized controlled trial. Ann Fam Med. 2017;15(5):427-433.

PreviousNext
Back to top

In this issue

The Annals of Family Medicine: 15 (5)
The Annals of Family Medicine: 15 (5)
Vol. 15, Issue 5
September/October 2017
  • Table of Contents
  • Index by author
  • Back Matter (PDF)
  • Front Matter (PDF)
  • In Brief
Print
Download PDF
Article Alerts
Sign In to Email Alerts with your Email Address
Email Article

Thank you for your interest in spreading the word on Annals of Family Medicine.

NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. We do not capture any email address.

Enter multiple addresses on separate lines or separate them with commas.
Tethered to the EHR: Primary Care Physician Workload Assessment Using EHR Event Log Data and Time-Motion Observations
(Your Name) has sent you a message from Annals of Family Medicine
(Your Name) thought you would like to see the Annals of Family Medicine web site.
CAPTCHA
This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
1 + 11 =
Solve this simple math problem and enter the result. E.g. for 1+3, enter 4.
Citation Tools
Tethered to the EHR: Primary Care Physician Workload Assessment Using EHR Event Log Data and Time-Motion Observations
Brian G. Arndt, John W. Beasley, Michelle D. Watkinson, Jonathan L. Temte, Wen-Jan Tuan, Christine A. Sinsky, Valerie J. Gilchrist
The Annals of Family Medicine Sep 2017, 15 (5) 419-426; DOI: 10.1370/afm.2121

Citation Manager Formats

  • BibTeX
  • Bookends
  • EasyBib
  • EndNote (tagged)
  • EndNote 8 (xml)
  • Medlars
  • Mendeley
  • Papers
  • RefWorks Tagged
  • Ref Manager
  • RIS
  • Zotero
Get Permissions
Share
Tethered to the EHR: Primary Care Physician Workload Assessment Using EHR Event Log Data and Time-Motion Observations
Brian G. Arndt, John W. Beasley, Michelle D. Watkinson, Jonathan L. Temte, Wen-Jan Tuan, Christine A. Sinsky, Valerie J. Gilchrist
The Annals of Family Medicine Sep 2017, 15 (5) 419-426; DOI: 10.1370/afm.2121
Twitter logo Facebook logo Mendeley logo
  • Tweet Widget
  • Facebook Like
  • Google Plus One

Jump to section

  • Article
    • Abstract
    • INTRODUCTION
    • METHODS
    • RESULTS
    • DISCUSSION
    • Footnotes
    • References
  • Figures & Data
  • eLetters
  • Info & Metrics
  • PDF

Related Articles

  • PubMed
  • Google Scholar

Cited By...

  • Comparing AI- versus clinician-authored summaries of simulated primary care electronic health records
  • A Novel Playbook for Pragmatic Trial Operations to Monitor and Evaluate Ambient Artificial Intelligence in Clinical Practice
  • For AI in Primary Care, Start With the Problem
  • Quantifying and Visualizing Emergency Physician Workflow: Results of an Observational Time-Motion Study
  • Physician Satisfaction Should Be the Measure of Electronic Health Record Quality for the Nation
  • Balancing act: the complex role of artificial intelligence in addressing burnout and healthcare workforce dynamics
  • Only One Quarter of Family Physicians Are Very Satisfied with Their Electronic Health Records Platform
  • Team-Based Management of High-Priority In-Basket Messages
  • Tracking persistent postoperative opioid use: a proof-of-concept study demonstrating a use case for natural language processing
  • The Ability of Primary Care Practices to Measure and Report on Care Quality
  • Comparative Analysis of Three Surveys on Primary Care Providers Experiences with Interoperability and Electronic Health Records
  • More Tethered to the EHR: EHR Workload Trends Among Academic Primary Care Physicians, 2019-2023
  • Leveraging Large Language Models for Generating Responses to Patient Messages
  • High cost of broken relationships
  • Transforming primary healthcare through natural language processing and big data analytics
  • Refining Vendor-Defined Measures to Accurately Quantify EHR Workload Outside Time Scheduled With Patients
  • Digital disparities among healthcare workers in typing speed between generations, genders, and medical specialties: cross sectional study
  • Physicians Attitudes towards Secondary Use of Clinical Data for Biomedical Research Purposes in Germany. Results of a Quantitative Survey
  • Physicians Choice of Board Certification Activity Is Unaffected by Baseline Quality of Care: The TRADEMaRQ Study
  • The Distressed State of Primary Care in Virginia Pre-Medicaid Expansion and Pre-Pandemic
  • A Narrative Review of Slow Medicine Outcomes
  • Electronic Health Record Technology Designed for the Clinical Encounter: MS NeuroShare
  • Direct Primary Care: Family Physician Perceptions of a Growing Model
  • Standardization vs Customization: Finding the Right Balance
  • Do Medical Scribes Help Primary Care Providers Respond More Quickly to Out-of-Visit Tasks?
  • Research on Artificial Intelligence and Primary Care: A Scoping Review
  • Which electronic health record system should we use? - a systematic review
  • Technology-enabled assessments to enhance multiple sclerosis clinical care and research
  • Artificial Intelligence and Primary Care Research: A Scoping Review
  • Primary Care Physician Factors Associated with Inbox Message Volume
  • Nephrology Fellows and Program Directors Perceptions of Hospital Rounds in the United States
  • Changes in Rates and Content of Primary Care Visits Within an Evolving Health Care System
  • CM-SHARE: Development, Integration, and Adoption of an Electronic Health Record-Linked Digital Health Solution to Support Care for Diabetes in Primary Care
  • How coping can hide larger systems problems: the routine immunisation supply chain in Bihar, India
  • Powering-Up Primary Care Teams: Advanced Team Care With In-Room Support
  • Characterizing Inpatient Medicine Resident Electronic Health Record Usage Patterns Using Event Log Data
  • The Mid-Career Demon
  • Playing the poor in the US
  • Tethered to the EHR: A Physician Workload Assessment
  • In This Issue: Tools to Help Focus on What is Valuable
  • Google Scholar

More in this TOC Section

  • Shared Decision Making Among Racially and/or Ethnically Diverse Populations in Primary Care: A Scoping Review of Barriers and Facilitators
  • Convenience or Continuity: When Are Patients Willing to Wait to See Their Own Doctor?
  • Feasibility and Acceptability of the “About Me” Care Card as a Tool for Engaging Older Adults in Conversations About Cognitive Impairment
Show more Original Research

Similar Articles

Subjects

  • Methods:
    • Mixed methods
  • Other research types:
    • Health policy
    • Health services
    • Professional practice
  • Other topics:
    • Health informatics
    • Organizational / practice change

Keywords

  • primary care
  • health information technology
  • electronic health records
  • workload
  • burnout
  • practice-based research

Content

  • Current Issue
  • Past Issues
  • Early Access
  • Plain-Language Summaries
  • Multimedia
  • Podcast
  • Articles by Type
  • Articles by Subject
  • Supplements
  • Calls for Papers

Info for

  • Authors
  • Reviewers
  • Job Seekers
  • Media

Engage

  • E-mail Alerts
  • e-Letters (Comments)
  • RSS
  • Journal Club
  • Submit a Manuscript
  • Subscribe
  • Family Medicine Careers

About

  • About Us
  • Editorial Board & Staff
  • Sponsoring Organizations
  • Copyrights & Permissions
  • Contact Us
  • eLetter/Comments Policy

© 2025 Annals of Family Medicine