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

Purpose: The purpose of this study is to evaluate recent trends in primary care physician (PCP) electronic health record (EHR) workload.

Methods: This longitudinal study observed the EHR use of 141 academic PCPs over 4 years (May 2019 to March 2023). Ambulatory full-time equivalency (aFTE), visit volume, and panel size were evaluated.

Refining Vendor-Defined Measures to Accurately Quantify EHR Workload Outside Time Scheduled With Patients.

Accurately quantifying clinician time spent on electronic health record (EHR) activities outside the time scheduled with patients is critical for understanding occupational stress associated with ambulatory clinic environments. We make 3 recommendations regarding EHR workload measures that are intended to capture time working in the EHR outside time scheduled with patients, formally defined as work outside of work (WOW): (1) separate all time working in the EHR outside of time scheduled with patients from time working in the EHR during time scheduled with patients, (2) do not exclude any time before or after scheduled time with patients, and (3) encourage the EHR vendor and research communities to develop and standardize validated, vendor-agnostic methods for measuring active EHR use. Attributing all EHR work outside time scheduled with patients to WOW, regardless of when it occurs, will produce an objective and standardized measure better suited for use in efforts to reduce burnout, set policy, and facilitate research.

Primary Care Patients' and Staff's Perceptions of Self-Rooming as Alternative to Waiting Rooms.

Purpose: Most patients are escorted to exam rooms (escorted rooming) although patients directing themselves to their exam room (self-rooming) saves patient and staff time while increasing patient satisfaction. This study assesses patient and staff perceptions after pragmatic implementation of self-rooming.

Methods: In October-December 2020, we surveyed patients and staff in 25 primary care clinics after our institution expanded self-rooming from 4 specially built clinics during the COVID-19 pandemic.

Does a Change in Physician Compensation Lead to Changes in Care Delivery in Family Medicine Clinics?

Background And Objectives: Many highly capitated systems still pay physicians based on relative value units (RVU), which may lead to excessive office visits. We reviewed electronic health records from the family medicine clinic panel members of 97 physicians and 42 residents to determine if a change from RVUs to panel-based compensation influenced care delivery as defined by the number of office visits and telephone contacts per panel member per month.

Methods: A retrospective analysis of the electronic health records of patients seen in 4 residency training clinics, 10 community clinics, and 4 regional clinics was conducted.

The effect of remote scribes on primary care physicians' wellness, EHR satisfaction, and EHR use.

Background: Physician burnout is a major problem in the United States. Small studies suggest scribes can improve clinician satisfaction, but scribe programs have not been evaluated using separate control groups or structured measures of electronic health record (EHR) use.

Methods: We conducted a pre-post, non-randomized controlled evaluation of a remote scribe pilot program introduced in September 2019 in an academic primary care practice.

Disparities in Use of Patient Portals Among Adults in Family Medicine.

Objective: This study examined patient portal utilization by analyzing the pattern of time and feature use of patients, and thus to identify functionalities of portal use and patient characteristics that may inform future strategies to enhance communication and care coordination through online portals.

Methods: We conducted a retrospective study of patients at 18 family medicine clinics over a 5-year period using access log records in the electronic health record database. Dimensionality reduction analysis was applied to group portal functionalities into 4 underlying feature domains: messaging, health information management, billing/insurance, and resource/education.

Reduction in Medication Refill Encounters Through Primary Care Redesign Workflow Changes.

With a goal of improving efficiency and reducing workload outside of visits, we sought to examine a primary care redesign process aimed at reducing refill requests made outside of office visits. Data on the number of refill encounters per panel member were collected at 17 clinics before, during, and after the implementation of a redesign process. There was an initial reduction in the number of medication refill encounters, and the rate of refill encounters continued to decline following implementation.

Expansion and Evaluation of Pharmacist Services in Primary Care.

Challenges with primary care access and overextended providers present opportunities for pharmacists as patient care extenders for chronic disease management. The primary objective was to align primary care pharmacist services with organizational priorities and improve patient clinical outcomes. The secondary objective was to develop a technological strategy for service evaluation.

Metrics for assessing physician activity using electronic health record log data.

Electronic health record (EHR) log data have shown promise in measuring physician time spent on clinical activities, contributing to deeper understanding and further optimization of the clinical environment. In this article, we propose 7 core measures of EHR use that reflect multiple dimensions of practice efficiency: total EHR time, work outside of work, time on documentation, time on prescriptions, inbox time, teamwork for orders, and an aspirational measure for the amount of undivided attention patients receive from their physicians during an encounter, undivided attention. We also illustrate sample use cases for these measures for multiple stakeholders.

Physician Burnout and Timing of Electronic Health Record Use.

Background: Rates of burnout among physicians have been high in recent years. The Electronic Health Record (EHR) is implicated as a major cause of burnout.

Objective: To determine the association between physician burnout and timing of EHR use in an academic internal medicine primary care practice.

Transforming a Family Medicine Residency Into a Community-Oriented Learning Environment.

Background And Objectives: Improvement in population health has become a key goal of health systems and payers in the United States. Because 80% of health outcomes are driven by social determinants of health beyond medical care and health care access, such improvements require attention to factors outside of the conventional areas of expertise for clinicians. Yet primary care physicians often graduate from training programs with few skills in population and community health.

Prevalence and Predictors of Unhealthy Weight Gain in Pregnancy.

Importance: Weight gain during pregnancy affects obesity risk in offspring.

Objective: To assess weight gain among UW Health prenatal patients and to identify predictors of unhealthy gestational weight gain.

Methods: Retrospective cohort study of women delivering at UW Health during 2007-2012.

Tethered to the EHR: Primary Care Physician Workload Assessment Using EHR Event Log Data and Time-Motion Observations.

Purpose: Primary care physicians spend nearly 2 hours on electronic health record (EHR) tasks per hour of direct patient care. Demand for non-face-to-face care, such as communication through a patient portal and administrative tasks, is increasing and contributing to burnout. The goal of this study was to assess time allocated by primary care physicians within the EHR as indicated by EHR user-event log data, both during clinic hours (defined as 8:00 am to 6:00 pm Monday through Friday) and outside clinic hours.

The Prevalence of Type 2 Diabetes Mellitus in a Wisconsin Hmong Patient Population.

Purpose: Wisconsin's largest Asian population, the Hmong, may be at high risk for type 2 diabetes. However, there are few population-based studies investigating the prevalence of diabetes in this population. This study compared the prevalence of diabetes between Hmong and non-Hispanic white patients of the University of Wisconsin departments of family medicine, pediatrics, and internal medicine clinics.

Sparse modeling of spatial environmental variables associated with asthma.

Geographically distributed environmental factors influence the burden of diseases such as asthma. Our objective was to identify sparse environmental variables associated with asthma diagnosis gathered from a large electronic health record (EHR) dataset while controlling for spatial variation. An EHR dataset from the University of Wisconsin's Family Medicine, Internal Medicine and Pediatrics Departments was obtained for 199,220 patients aged 5-50years over a three-year period.

Panel workload assessment in US primary care: accounting for non-face-to-face panel management activities.

Purpose: An understanding of primary care provider (PCP) workload is an important consideration in establishing optimal PCP panel size. However, no widely acceptable measure of PCP workload exists that incorporates the effort involved with both non-face-to-face patient care activities and face-to-face encounters. Accounting for this gap is critical given the increase in non-face-to-face PCP activities that has accompanied electronic health records (EHRs) (eg, electronic messaging).

Depression and diabetes: the role and impact of models of health care systems.

Objectives: Depression and diabetes often occur together and their comorbidity has a significant and detrimental impact on health outcomes. The aims of this paper are to review the existing international literature on approaches to health care for comorbid depression and diabetes and draw out the key conclusions for both research and future development in health care delivery.

Methods: Narrative review of the literature with synthesis by an international team of authors.

The theory and application of UW ehealth-PHINEX, a clinical electronic health record-public health information exchange.

Background: Electronic health records (EHRs) hold the promise of improving clinical quality and population health while reducing health care costs. However, it is not clear how these goals can be achieved in practice.

Methods: Clinician-led teams developed EHR data extracts to support chronic disease use cases.