More Tethered to the EHR: EHR Workload Trends Among Academic Primary Care Physicians, 2019-2023

Brian G. Arndt; Mark A. Micek; Adam Rule; Christina M. Shafer; Jeffrey J. Baltus; Christine A. Sinsky

doi:10.1370/afm.3047

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RE: Comparison metrics from another organization
C. Becket Mahnke

Published on: 01 March 2024
RE: Not all EHR news is bad
C. Becket Mahnke and J. Makrina Shanbour

Published on: 16 February 2024
RE: EHR Workload
Henry R. Ivey, Jr.

Published on: 23 January 2024
aFTE and Panel Definition?
Daisuke Yamashita

Published on: 23 January 2024

Published on: (1 March 2024)
Page navigation anchor for RE: Comparison metrics from another organization
RE: Comparison metrics from another organization
C. Becket Mahnke, CMIO, Confluence Health
(re-submitting as I recalculated some measures for comparison--trivial differences only)
Given our concern for provider wellness, we appreciate the contribution by Arndt et al. We also wanted to briefly contribute our experience as it differs significantly, and we believe it offers hope that things can be better.

As participants in the AMA’s Joy in Medicine program we have been calculating EHR time-based measures for the last 2 years (indexed to 8 hrs of scheduled appointments). It was also helpful to compare our indexed EHR time measures and Inbox volume to the authors’ findings to compare Primary Care practice patterns. In 2023 our EHR(8) time was 326 min, (65 minutes/17% less than Arndt et al). Our Work Outside of Work (WOW(8)= time outside of scheduled hours + time on unscheduled days) was 54 min (112 minutes/67% less than Arndt et al). Our Inbox volumes were also significantly less for Patient Calls (7.0 vs. 23.5 per 8 hours scheduled time) and Patient Medical Advice Requests (6.4 vs. 15.3 per 8 hours scheduled time).

During the last 2 years our time-based EHR measures have improved, contrary to the experience reported by Arndt et al. We have seen a decrease in total EHR(8) time of 34 min and Work Outside of Work (WOW(8)) of 16 min for our Primary Care group consisting of physicians and APP’s in Family Medicine, Internal Medicine, and Pediatrics.

While we appreciate that there is likely some variation between practice settings, we...
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(re-submitting as I recalculated some measures for comparison--trivial differences only)
Given our concern for provider wellness, we appreciate the contribution by Arndt et al. We also wanted to briefly contribute our experience as it differs significantly, and we believe it offers hope that things can be better.

As participants in the AMA’s Joy in Medicine program we have been calculating EHR time-based measures for the last 2 years (indexed to 8 hrs of scheduled appointments). It was also helpful to compare our indexed EHR time measures and Inbox volume to the authors’ findings to compare Primary Care practice patterns. In 2023 our EHR(8) time was 326 min, (65 minutes/17% less than Arndt et al). Our Work Outside of Work (WOW(8)= time outside of scheduled hours + time on unscheduled days) was 54 min (112 minutes/67% less than Arndt et al). Our Inbox volumes were also significantly less for Patient Calls (7.0 vs. 23.5 per 8 hours scheduled time) and Patient Medical Advice Requests (6.4 vs. 15.3 per 8 hours scheduled time).

During the last 2 years our time-based EHR measures have improved, contrary to the experience reported by Arndt et al. We have seen a decrease in total EHR(8) time of 34 min and Work Outside of Work (WOW(8)) of 16 min for our Primary Care group consisting of physicians and APP’s in Family Medicine, Internal Medicine, and Pediatrics.

While we appreciate that there is likely some variation between practice settings, we feel it is important to highlight that it is indeed possible to provide high-quality primary care with much less provider EHR time and Inbox burden than reported by Arndt et al. We are grateful to our wonderful support staff, our EHR educators, and our team-based care approach. We are actively focused on measuring time and task volume for the entire care team for ongoing improvement for all EHR users.
Show Less

Competing Interests: None declared.
Published on: (16 February 2024)
Page navigation anchor for RE: Not all EHR news is bad
RE: Not all EHR news is bad
C. Becket Mahnke, Chief Medical Information Officer, Confluence Health
Other Contributors:
J. Makrina Shanbour, Chief Wellness Physician
Given our concern for provider wellness, we appreciate the contribution by Arndt et al. We also wanted to briefly contribute our experience as it differs significantly, and we believe it offers hope that things can be better.

As participants in the AMA’s Joy in Medicine program we have been calculating EHR time-based measures for the last 2 years (indexed to 8 hrs of scheduled appointments). It was also helpful to compare our indexed EHR time measures and Inbox volume to the authors’ findings to compare Primary Care practice patterns. In 2023 our EHR(8) time was 326 min, (65 minutes/17% less than Arndt et al). Our Work Outside of Work (WOW(8)= time outside of scheduled hours + time on unscheduled days) was 54 min (112 minutes/67% less than Arndt et al). Our Inbox volumes were also significantly less for Patient Calls (6.2 vs. 23.5 per 8 hours scheduled time) and Patient Medical Advice Requests (5.7 vs. 15.3 per 8 hours scheduled time).

During the last 2 years our time-based EHR measures have improved, contrary to the experience reported by Arndt et al. We have seen a decrease in total EHR(8) time of 34 min and Work Outside of Work (WOW(8)) of 16 min for our Primary Care group consisting of physicians and APP’s in Family Medicine, Internal Medicine, and Pediatrics.

While we appreciate that there is likely some variation between practice settings, we feel it is important to highlight that it is indeed possible to provide high-quality primary ca...
Show More

Given our concern for provider wellness, we appreciate the contribution by Arndt et al. We also wanted to briefly contribute our experience as it differs significantly, and we believe it offers hope that things can be better.

As participants in the AMA’s Joy in Medicine program we have been calculating EHR time-based measures for the last 2 years (indexed to 8 hrs of scheduled appointments). It was also helpful to compare our indexed EHR time measures and Inbox volume to the authors’ findings to compare Primary Care practice patterns. In 2023 our EHR(8) time was 326 min, (65 minutes/17% less than Arndt et al). Our Work Outside of Work (WOW(8)= time outside of scheduled hours + time on unscheduled days) was 54 min (112 minutes/67% less than Arndt et al). Our Inbox volumes were also significantly less for Patient Calls (6.2 vs. 23.5 per 8 hours scheduled time) and Patient Medical Advice Requests (5.7 vs. 15.3 per 8 hours scheduled time).

During the last 2 years our time-based EHR measures have improved, contrary to the experience reported by Arndt et al. We have seen a decrease in total EHR(8) time of 34 min and Work Outside of Work (WOW(8)) of 16 min for our Primary Care group consisting of physicians and APP’s in Family Medicine, Internal Medicine, and Pediatrics.

While we appreciate that there is likely some variation between practice settings, we feel it is important to highlight that it is indeed possible to provide high-quality primary care with much less provider EHR time and Inbox burden than reported by Arndt et al. We are grateful to our wonderful support staff, our EHR educators, and our team-based care approach. We are actively focused on measuring time and task volume for the entire care team for ongoing improvement for all EHR users.
Show Less

Competing Interests: None declared.
Published on: (23 January 2024)
Page navigation anchor for RE: EHR Workload
RE: EHR Workload
Henry R. Ivey, Jr., Family Physician, Bon Secours Mercy Health
While this is a very interesting analysis, the findings will be of no surprise to any primary care physician. Clinicians and health systems continue to struggle with the time-consuming issue of EHR workload.

I would like to second the notion that this study likely underestimates the time required of clinicians to respond to the growing EHR demands. For instance, I frequently check EHR messages from fellow clinicians and (especially) from patients BETWEEN visits and through my "lunch break" (usually neither lunch nor break). I don't believe that this study adequately captured that time responding to EHR messages.

In addition, if the EHR stopped counting the time required when responding to messages when there was no entry for several seconds, it would miss counting the often significant time that I was researching an answer before responding (Epic, UpToDate, etc.).

Thanks to the authors for confirming what we have all felt regarding this growing (and usually uncompensated) intrusion on our clinical and family time.

Competing Interests: None declared.
Published on: (23 January 2024)
Page navigation anchor for aFTE and Panel Definition?
aFTE and Panel Definition?
Daisuke Yamashita, Family Medicine, Oregon Health & Science University
I read the article with great interest as a faculty member in a similar academic institution and have been thinking about tackling this ever-increasing non-visit work. The findings are not surprising and we are seeing the similar trend in our institution. I have questions for the authors. 1. What is the definition of aFTE? aFTE includes any administrative time or scholarly time? 2. What is the definition of panel in this study? Does the panel definition include advanced features such as non-visit communication to be included in the criteria to remain in the PCP panel? What is the visit requirement to be remain on the panel? 18 months? 36 months?. I ask since the panel per one aFTE looks much higher compared to what we see in my institution or in Oregon. (more around 1200-1500). 3. Does aFTE have any time built in to do non-visit work? I ask since the article mentions 45% of the population is in the capitated model. Again thank you for the great article. Very relevant to our work.

Competing Interests: None declared.