title: The electronic health record audit file: the patient is waiting.
abstract: OBJECTIVE
  We describe how electronic health record (EHR) audit files can be used to understand how time is spent in primary care (PC).
  
  
  METHODS
  We used audit file data from the Geisinger Clinic to quantify elements of the clinical workflow and to determine how these times vary by patient and encounter factors. We randomly selected audit file records representing 36 437 PC encounters across 26 clinic locations. Audit file data were used to estimate duration and variance of: (1) time in the waiting room, (2) nurse time with the patient, (3) time in the exam room without a nurse or physician, and (4) physician time with the patient. Multivariate modeling was used to test for differences by patient and by encounter features.
  
  
  RESULTS
  On average, a PC encounter took 54.6 minutes, with 5 minutes of nurse time, 15.5 minutes of physician time, and the remaining 62% of the time spent waiting to see a clinician or check out. Older age, female sex, and chronic disease were associated with longer wait times and longer time with clinicians. Level of service and numbers of medications, procedures, and lab orders were associated with longer time with clinicians. Late check-in and same-day visits were associated with shorter wait time and clinician time.
  
  
  CONCLUSIONS
  This study provides insights on uses of audit file data for workflow analysis during PC encounters.
  
  
  CONCLUSIONS
  Scalable ways to quantify clinical encounter workflow elements may provide the means to develop more efficient approaches to care and improve the patient experience.
authors.affiliation: Center for Health Research, Geisinger Health System, Danville, Pennsylvania.
authors.forename: Annemarie G
authors.initials: AG
authors.lastname: Hirsch
authors.affiliation: Research Development and Dissemination, Sutter Health, San Francisco, California.
authors.forename: J B
authors.initials: JB
authors.lastname: Jones
authors.affiliation: Institute for Advanced Applications, Geisinger Health System, Danville, Pennsylvania.
authors.forename: Virginia R
authors.initials: VR
authors.lastname: Lerch
authors.affiliation: Allegheny Health Network, Pittsburgh, Pennsylvania.
authors.forename: Xiaoqin
authors.initials: X
authors.lastname: Tang
authors.affiliation: Center for Health Research, Geisinger Health System, Danville, Pennsylvania.
authors.forename: Andrea
authors.initials: A
authors.lastname: Berger
authors.affiliation: Department of Clinical Innovation, Geisinger Health System, Danville, Pennsylvania.
authors.forename: Deserae N
authors.initials: DN
authors.lastname: Clark
authors.affiliation: Research Development and Dissemination, Sutter Health, San Francisco, California.
authors.forename: Walter F
authors.initials: WF
authors.lastname: Stewart
mesh_terms: D000554:Ambulatory Care Facilities / Q000458:organization & administration*; D057286:Electronic Health Records; D006302:Health Services Research; D006801:Humans; D016014:Linear Models; D009726:Nurses; D010414:Pennsylvania; D010820:Physicians; D011320:Primary Health Care / Q000458:organization & administration*; D011786:Quality Control; D012189:Retrospective Studies; D057188:Workflow
keywords: electronic health records; primary health care; workflow