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Published in: BMC Health Services Research 1/2016

Open Access 01-12-2016 | Research article

National estimates of the impact of electronic health records on the workload of primary care physicians

Authors: Jaeyong Bae, William E. Encinosa

Published in: BMC Health Services Research | Issue 1/2016

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Abstract

Background

Eighty-four thousand primary care physicians have received $1.3 billion in HITECH payments for EHR adoption. However, little is known about how this will impact primary care workload efficiency and the national primary care shortage. This study examines whether EHR is associated with increases in face time with the patient per visit and increases in the physician’s patient volume per week.

Methods

We used a nationally representative sample of 37,962 patient visits to 1470 primary care physicians during the pre-HITECH years 2006–2009 from the restricted-access version of the National Ambulatory Medical Care Survey. Quantile regressions were used to estimate the effects of EHR use on patient face time per visit and physician’s patient volume per week at different points of the time and volume distributions.

Results

Primary care physicians with EHR spend an extra 1.3 face time minutes per visit, or 1.5 extra hours per week. This is 34,000 extra hours of face time per week in the U.S. However, physician age matters. Among young physicians, EHR use is associated with a decline in weekly patient volume, while EHR use among older physicians is associated with an increase in volume, regardless of initial practice size. If younger physicians behaved like older physicians when adopting EHR, there would be 37,600 additional patient visits per week in the U.S., the equivalent of adding 500 more primary care physicians to the U.S. workforce.

Conclusion

EHR can enhance productivity/efficiency in primary care physician workloads.
Appendix
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Footnotes
1
For example, at 10 min visits for young physicians, the full impact of EHR from Table 2 is the sum of the coefficients: EHR + EHR*young = .053 + .016 = .069. Not shown, the standard error for this sum is estimated to be .017, so the full effect of 0.069 has a p-value < 0.001. This 0.069 is then log retransformed, giving 0.071 as the full effect of EHR on 10 min visit time for young physicians. This 0.071 effect is the point plotted in Fig. 1 for young doctors at 10 min visits. Similar computations underlie all the final full effects of EHR plotted in Exhibits 2 and 3.
 
2
For example, for the young physicians, the full effect of EHR in Table 2, col 1, is the sum of the coefficients: EHR + EHR*young = .067 (SE = .015). Log retransforming 0.067 gives a 7 % effect.
 
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Metadata
Title
National estimates of the impact of electronic health records on the workload of primary care physicians
Authors
Jaeyong Bae
William E. Encinosa
Publication date
01-12-2016
Publisher
BioMed Central
Published in
BMC Health Services Research / Issue 1/2016
Electronic ISSN: 1472-6963
DOI
https://doi.org/10.1186/s12913-016-1422-6

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