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Electronic Health Record Impact on Work Burden in Small, Unaffiliated, Community-Based Primary Care Practices

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ABSTRACT

BACKGROUND

The use of electronic health records (EHR) is widely recommended as a means to improve the quality, safety and efficiency of US healthcare. Relatively little is known, however, about how implementation and use of this technology affects the work of clinicians and support staff who provide primary health care in small, independent practices.

OBJECTIVE

To study the impact of EHR use on clinician and staff work burden in small, community-based primary care practices.

DESIGN

We conducted in-depth field research in seven community-based primary care practices. A team of field researchers spent 9–14 days over a 4–8 week period observing work in each practice, following patients through the practices, conducting interviews with key informants, and collecting documents and photographs. Field research data were coded and analyzed by a multidisciplinary research team, using a grounded theory approach.

PARTICIPANTS

All practice members and selected patients in seven community-based primary care practices in the Northeastern US.

KEY RESULTS

The impact of EHR use on work burden differed for clinicians compared to support staff. EHR use reduced both clerical and clinical staff work burden by improving how they check in and room patients, how they chart their work, and how they communicate with both patients and providers. In contrast, EHR use reduced some clinician work (i.e., prescribing, some lab-related tasks, and communication within the office), while increasing other work (i.e., charting, chronic disease and preventive care tasks, and some lab-related tasks). Thoughtful implementation and strategic workflow redesign can mitigate the disproportionate EHR-related work burden for clinicians, as well as facilitate population-based care.

CONCLUSIONS

The complex needs of the primary care clinician should be understood and considered as the next iteration of EHR systems are developed and implemented.

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Funding

This work was supported by a grant from the National Heart, Lung and Blood Institute (R21HL092046).

Conflict of Interest

Elizabeth C. Clark: Demissie K, PI; Clark EC, co-investigator. “Long term medication adherence in renal transplant patients.” Novartis Pharmaceuticals. 2011–2012; annual direct costs: $72,000. Benjamin F. Crabtree: royalties from Sage Publications, Inc. for edited book, Doing Qualitative Research.

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Authors and Affiliations

  1. Department of Family Medicine and Community Health, UMDNJ-Robert Wood Johnson Medical School, Somerset, NJ, USA

    Jenna Howard PhD, Elizabeth C. Clark MD, MPH, Asia Friedman PhD, Jesse C. Crosson PhD, Maria Pellerano MA, MBA, MPH & Benjamin F. Crabtree PhD

  2. University of Wisconsin, Madison, USA

    Ben-Tzion Karsh PhD

  3. University of Texas Health Science Center, San Antonio, USA

    Carlos R. Jaen MD, PhD

  4. RAND corporation, University of California, Los Angeles, USA

    Douglas S. Bell MD, PhD

  5. Oregon Health and Science University, Portland, USA

    Deborah J. Cohen PhD

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  1. Jenna Howard PhD
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Correspondence to Jenna Howard PhD.

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Howard, J., Clark, E.C., Friedman, A. et al. Electronic Health Record Impact on Work Burden in Small, Unaffiliated, Community-Based Primary Care Practices. J GEN INTERN MED 28, 107–113 (2013). https://doi.org/10.1007/s11606-012-2192-4

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  • DOI: https://doi.org/10.1007/s11606-012-2192-4

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