title: Face time versus test ordering: is there a trade-off?
abstract: BACKGROUND
  As clinician-patient face time comes under pressure, clinicians might consider substituting testing for time spent in diagnostic reasoning, history, and physical exam.
  
  
  OBJECTIVE
  To explore the relationship between clinician-patient time and medical resource utilization.
  
  
  METHODS
  In the Massachusetts General Hospital/Massachusetts General Physician Organization outpatient radio frequency identification project, clinicians and patients wore real-time location system (RTLS) tags. "Face time" was defined as the duration patients and clinicians were colocated. Radiology testing was used as a proxy for medical resource use. A radiology test was determined to be associated with a clinical encounter if it involved the same patient and clinician and occurred less than 3 months after the index encounter. Radiologic data were derived from the electronic health record and test appropriateness proxy score from the radiology order entry system. Data were synthesized and analyzed using standard structured query language and statistical analysis.
  
  
  RESULTS
  From July 2008 to October 2010, 2086 clinical encounter medical records and RTLSmeasured face times could be associated: 1957 for primary care (PC) and 129 for urgent care (UC). Of these, 471 met study criteria. In PC, shorter face time was associated with more testing, but shorter wait times and flow times. In UC, testing was not associated with shorter face times, but was associated with shorter wait times and longer flow times.
  
  
  CONCLUSIONS
  Our pilot suggests RTLS can capture face time and trade-offs between face time and testing. Ongoing studies will elucidate how these trade-offs affect patients, clinicians, and healthcare systems.
authors: Institute for Technology Assessment, Massachusetts General Hospital, 101 Merrimac St, 10th Fl, Boston, MA 02114. E-mail: jstahl@partners.org.
authors: James E
authors: JE
authors: Stahl
authors: Mark A
authors: MA
authors: Drew
authors: Jeffrey
authors: J
authors: Weilburg
authors: Chris
authors: C
authors: Sistrom
authors: Alexa B
authors: AB
authors: Kimball
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000553:Ambulatory Care; D057286:Electronic Health Records; D005260:Female; D006801:Humans; D008297:Male; D008404:Massachusetts; D008875:Middle Aged; D010817:Physician-Patient Relations; D010865:Pilot Projects; D057233:Radio Frequency Identification Device; D011859:Radiography / Q000706:statistics & numerical data*; D013997:Time Factors; D057188:Workflow; D055815:Young Adult