title: Electronic Health Record Logs Indicate That Physicians Split Time Evenly Between Seeing Patients And Desktop Medicine.
abstract: Time spent by physicians is a key resource in health care delivery. This study used data captured by the access time stamp functionality of an electronic health record (EHR) to examine physician work effort. This is a potentially powerful, yet unobtrusive, way to study physicians' use of time. We used data on physicians' time allocation patterns captured by over thirty-one million EHR transactions in the period 2011-14 recorded by 471 primary care physicians, who collectively worked on 765,129 patients' EHRs. Our results suggest that the physicians logged an average of 3.08 hours on office visits and 3.17 hours on desktop medicine each day. Desktop medicine consists of activities such as communicating with patients through a secure patient portal, responding to patients' online requests for prescription refills or medical advice, ordering tests, sending staff messages, and reviewing test results. Over time, log records from physicians showed a decline in the time allocated to face-to-face visits, accompanied by an increase in time allocated to desktop medicine. Staffing and scheduling in the physician's office, as well as provider payment models for primary care practice, should account for these desktop medicine efforts.
authors.affiliation: Ming Tai-Seale (tai-sealem@pamfri.org) is associate director of the Palo Alto Medical Foundation Research Institute, in Mountain View, California.
authors.forename: Ming
authors.initials: M
authors.lastname: Tai-Seale
authors.affiliation: Cliff W. Olson is director of the Information Management Group at the Palo Alto Medical Foundation Research Institute.
authors.forename: Cliff W
authors.initials: CW
authors.lastname: Olson
authors.affiliation: Jinnan Li is a quantitative analyst at the Palo Alto Medical Foundation Research Institute.
authors.forename: Jinnan
authors.initials: J
authors.lastname: Li
authors.affiliation: Albert S. Chan is vice president for digital patient experience at Sutter Health, in Emeryville, California.
authors.forename: Albert S
authors.initials: AS
authors.lastname: Chan
authors.affiliation: Criss Morikawa is director of data and analytics at the Palo Alto Medical Foundation, in Mountain View, California.
authors.forename: Criss
authors.initials: C
authors.lastname: Morikawa
authors.affiliation: Meg Durbin is chief medical officer at Canopy Health, in Emeryville, California.
authors.forename: Meg
authors.initials: M
authors.lastname: Durbin
authors.affiliation: Wei Wang is a data scientist at Intuit Inc., in Mountain View.
authors.forename: Wei
authors.initials: W
authors.lastname: Wang
authors.affiliation: Harold S. Luft is director of the Palo Alto Medical Foundation Research Institute.
authors.forename: Harold S
authors.initials: HS
authors.lastname: Luft
mesh_terms: D000328:Adult; D057286:Electronic Health Records / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D009819:Office Visits / Q000639:trends; D010817:Physician-Patient Relations; D058007:Physicians, Primary Care / Q000706:statistics & numerical data*; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011320:Primary Health Care / Q000379:methods / Q000639:trends; D013997:Time Factors
keywords: Electronic Health Record; Physicians; Primary Care