Tethered to the EHR: A Physician Workload Assessment
====================================================

* Roma P. Amin
* Michael E. Johansen

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 and click on “TRACK Discussion/ Submit a comment.”) Discussion questions and information are online at: [http://www.annfammed.org/site/AJC/](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.[Abstract/FREE Full Text](http://www.annfammed.org/lookup/ijlink/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiQUJTVCI7czoxMToiam91cm5hbENvZGUiO3M6ODoiYW5uYWxzZm0iO3M6NToicmVzaWQiO3M6ODoiMTUvNS80MTkiO3M6NDoiYXRvbSI7czoyMzoiL2FubmFsc2ZtLzE1LzUvaWlpLmF0b20iO31zOjg6ImZyYWdtZW50IjtzOjA6IiI7fQ==)

### 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 topi?

*   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?

*   © 2017 Annals of Family Medicine, Inc.

## 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/cgi/content/full/4/3/196](http://annfammed.org/cgi/content/full/4/3/196).
    
    [FREE Full Text](http://www.annfammed.org/lookup/ijlink/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiRlVMTCI7czoxMToiam91cm5hbENvZGUiO3M6ODoiYW5uYWxzZm0iO3M6NToicmVzaWQiO3M6NzoiNC8zLzE5NiI7czo0OiJhdG9tIjtzOjIzOiIvYW5uYWxzZm0vMTUvNS9paWkuYXRvbSI7fXM6ODoiZnJhZ21lbnQiO3M6MDoiIjt9) 

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.
    
    [Abstract/FREE Full Text](http://www.annfammed.org/lookup/ijlink/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiQUJTVCI7czoxMToiam91cm5hbENvZGUiO3M6ODoiYW5uYWxzZm0iO3M6NToicmVzaWQiO3M6ODoiMTUvNS80MjciO3M6NDoiYXRvbSI7czoyMzoiL2FubmFsc2ZtLzE1LzUvaWlpLmF0b20iO31zOjg6ImZyYWdtZW50IjtzOjA6IiI7fQ==)