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Association Between Electronic Health Record Time and Quality of Care Metrics in Primary Care
IMPORTANCE: Physicians across the US spend substantial time working in the electronic health record (EHR), with primary care physicians (PCPs) spending the most time. The association between EHR time and ambulatory care quality outcomes is unclear. OBJECTIVE: To characterize measures of EHR use and...
Autores principales: | , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
American Medical Association
2022
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9579903/ https://www.ncbi.nlm.nih.gov/pubmed/36255725 http://dx.doi.org/10.1001/jamanetworkopen.2022.37086 |
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author | Rotenstein, Lisa S. Holmgren, A. Jay Healey, Michael J. Horn, Daniel M. Ting, David Y. Lipsitz, Stuart Salmasian, Hojjat Gitomer, Richard Bates, David W. |
author_facet | Rotenstein, Lisa S. Holmgren, A. Jay Healey, Michael J. Horn, Daniel M. Ting, David Y. Lipsitz, Stuart Salmasian, Hojjat Gitomer, Richard Bates, David W. |
author_sort | Rotenstein, Lisa S. |
collection | PubMed |
description | IMPORTANCE: Physicians across the US spend substantial time working in the electronic health record (EHR), with primary care physicians (PCPs) spending the most time. The association between EHR time and ambulatory care quality outcomes is unclear. OBJECTIVE: To characterize measures of EHR use and ambulatory care quality performance among PCPs. DESIGN, SETTING, AND PARTICIPANTS: A cross-sectional study of PCPs with longitudinal patient panels using a single EHR vendor was conducted at Brigham and Women’s Hospital and Massachusetts General Hospital during calendar year 2021. EXPOSURES: Independent variables included PCPs demographic and practice characteristics and EHR time measures (PCP-level mean of daily total EHR time, after-hours time, time from 5:30 pm to 7:00 am and time on weekends, and daily EHR time on notes, sending and receiving patient, staff, results, prescription, or system messages [in-basket], and clinical review). MAIN OUTCOMES AND MEASURES: Outcome variables were ambulatory quality measures (year-end, PCP panel–level achievement of targets for hemoglobin A(1c) level control, lipid management, hypertension control, diabetes screening, and breast cancer screening). RESULTS: The sample included 291 physicians (174 [59.8%] women). Median panel size was 829 (IQR, 476-1157) patients and mean (SD) clinical full-time equivalent was 0.54 (0.27). The PCPs spent a mean (SD) of 145.9 (64.6) daily minutes on the EHR. There were significant associations between EHR time and panel-level achievement of hemoglobin A(1c) control, hypertension control, and breast cancer screening targets. In adjusted analyses, each additional 15 minutes of total daily EHR time was associated with 0.58 (95% CI, 0.32-0.84) percentage point greater panel-level hemoglobin A(1c) control, 0.52 (95% CI, 0.33-0.71) percentage point greater hypertension control, and 0.28 (95% CI, 0.05-0.52) higher breast cancer screening rates. Each daily additional 15 minutes of in-basket time was associated with 2.26 (95% CI, 1.05-3.48) greater panel-wide hemoglobin A(1c) control, 1.65 (95% CI, 0.83-2.47) percentage point greater hypertension control, and 1.26 (95% CI, 0.51-2.02) percentage point higher breast cancer screening rates. Associations were largely concentrated among PCPs with 0.5 clinical full-time equivalent or less. There were no associations between EHR use metrics and diabetes screening or lipid management in patients with cardiovascular disease. CONCLUSIONS AND RELEVANCE: This cross-sectional study found an association between EHR time and some measures of ambulatory care quality. Although increased EHR time is associated with burnout, it may represent a level of thoroughness or communication that enhances certain outcomes. It may be useful for future studies to characterize payment models, workflows, and technologies that enable high-quality ambulatory care delivery while minimizing EHR burden. |
format | Online Article Text |
id | pubmed-9579903 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | American Medical Association |
record_format | MEDLINE/PubMed |
spelling | pubmed-95799032022-11-04 Association Between Electronic Health Record Time and Quality of Care Metrics in Primary Care Rotenstein, Lisa S. Holmgren, A. Jay Healey, Michael J. Horn, Daniel M. Ting, David Y. Lipsitz, Stuart Salmasian, Hojjat Gitomer, Richard Bates, David W. JAMA Netw Open Original Investigation IMPORTANCE: Physicians across the US spend substantial time working in the electronic health record (EHR), with primary care physicians (PCPs) spending the most time. The association between EHR time and ambulatory care quality outcomes is unclear. OBJECTIVE: To characterize measures of EHR use and ambulatory care quality performance among PCPs. DESIGN, SETTING, AND PARTICIPANTS: A cross-sectional study of PCPs with longitudinal patient panels using a single EHR vendor was conducted at Brigham and Women’s Hospital and Massachusetts General Hospital during calendar year 2021. EXPOSURES: Independent variables included PCPs demographic and practice characteristics and EHR time measures (PCP-level mean of daily total EHR time, after-hours time, time from 5:30 pm to 7:00 am and time on weekends, and daily EHR time on notes, sending and receiving patient, staff, results, prescription, or system messages [in-basket], and clinical review). MAIN OUTCOMES AND MEASURES: Outcome variables were ambulatory quality measures (year-end, PCP panel–level achievement of targets for hemoglobin A(1c) level control, lipid management, hypertension control, diabetes screening, and breast cancer screening). RESULTS: The sample included 291 physicians (174 [59.8%] women). Median panel size was 829 (IQR, 476-1157) patients and mean (SD) clinical full-time equivalent was 0.54 (0.27). The PCPs spent a mean (SD) of 145.9 (64.6) daily minutes on the EHR. There were significant associations between EHR time and panel-level achievement of hemoglobin A(1c) control, hypertension control, and breast cancer screening targets. In adjusted analyses, each additional 15 minutes of total daily EHR time was associated with 0.58 (95% CI, 0.32-0.84) percentage point greater panel-level hemoglobin A(1c) control, 0.52 (95% CI, 0.33-0.71) percentage point greater hypertension control, and 0.28 (95% CI, 0.05-0.52) higher breast cancer screening rates. Each daily additional 15 minutes of in-basket time was associated with 2.26 (95% CI, 1.05-3.48) greater panel-wide hemoglobin A(1c) control, 1.65 (95% CI, 0.83-2.47) percentage point greater hypertension control, and 1.26 (95% CI, 0.51-2.02) percentage point higher breast cancer screening rates. Associations were largely concentrated among PCPs with 0.5 clinical full-time equivalent or less. There were no associations between EHR use metrics and diabetes screening or lipid management in patients with cardiovascular disease. CONCLUSIONS AND RELEVANCE: This cross-sectional study found an association between EHR time and some measures of ambulatory care quality. Although increased EHR time is associated with burnout, it may represent a level of thoroughness or communication that enhances certain outcomes. It may be useful for future studies to characterize payment models, workflows, and technologies that enable high-quality ambulatory care delivery while minimizing EHR burden. American Medical Association 2022-10-18 /pmc/articles/PMC9579903/ /pubmed/36255725 http://dx.doi.org/10.1001/jamanetworkopen.2022.37086 Text en Copyright 2022 Rotenstein LS et al. JAMA Network Open. https://creativecommons.org/licenses/by/4.0/This is an open access article distributed under the terms of the CC-BY License. |
spellingShingle | Original Investigation Rotenstein, Lisa S. Holmgren, A. Jay Healey, Michael J. Horn, Daniel M. Ting, David Y. Lipsitz, Stuart Salmasian, Hojjat Gitomer, Richard Bates, David W. Association Between Electronic Health Record Time and Quality of Care Metrics in Primary Care |
title | Association Between Electronic Health Record Time and Quality of Care Metrics in Primary Care |
title_full | Association Between Electronic Health Record Time and Quality of Care Metrics in Primary Care |
title_fullStr | Association Between Electronic Health Record Time and Quality of Care Metrics in Primary Care |
title_full_unstemmed | Association Between Electronic Health Record Time and Quality of Care Metrics in Primary Care |
title_short | Association Between Electronic Health Record Time and Quality of Care Metrics in Primary Care |
title_sort | association between electronic health record time and quality of care metrics in primary care |
topic | Original Investigation |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9579903/ https://www.ncbi.nlm.nih.gov/pubmed/36255725 http://dx.doi.org/10.1001/jamanetworkopen.2022.37086 |
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