Electronic Health Record Time Allocation Among Primary Care Clinicians at the Veterans Health Administration Using Virtual Observations

Background: Prior research has shown that primary care clinicians (PCPs) spend a large portion of clinic visits on tasks within the electronic health record (EHR). However, no time allocation studies have been done in the Veterans Health Administration (VHA) and little is known about EHR time spent during virtual visits.

Objective: To estimate the proportion of clinician time spent working within the EHR during primary care visits at VHA clinics.

Design: We used a time study software (WorkStudy+) adapted from prior research to collect time-motion data via remote observation of in-person and virtual visits.

Participants: 23 PCPs (including physicians and nurse practitioners) from 3 regional VA sites.

Main measures: Proportion of observed time spent interfacing with the EHR during a primary care visit.

Key results: Of 211 primary care visits observed, the average visit length was 23.9 min in-person, 21.2 min by phone, and 29.3 min on video. The percentage of time spent on EHR work during the visit was 35% for in-person visits, 46% for phone visits, and 39% for video visits. During n=39 4-h clinic sessions, PCPs spent 54 min completing administrative tasks between patient visits, with 44% of time spent on documentation, 14% on chart review, and 14% on placing orders.

Conclusions: PCPs at the VHA spend between one-third and one-half of each patient visit interfacing with the EHR. Most of this time is spent on documentation and chart review. Less time was spent in the EHR during in-person visits compared to virtual visits, suggesting that clinicians limit EHR task completion when the patient is present. Between patient visits during clinic sessions, PCPs spend 75% of their time working in the EHR. In total, this represents over 2 h per half-day clinic session spent on EHR tasks.