Community Health Center PCPs Spend Less Time on EHR, Electronic Inbox

Primary care physicians (PCPs) practicing in community health centers spend less time using the EHR than other PCPs, according to a study published in JAMA Network Open.

The cross-sectional study included 307 PCPs practicing across 31 primary care clinics at Massachusetts General Hospital and Brigham and Women’s Hospital during 2021.

Overall, practicing in a community health center was associated with 5.40 fewer minutes of EHR time per visit, including time on the electronic inbox.

The study authors also acknowledged that the finding of community health center PCPs spending less time on the EHR and electronic inbox could reflect lower levels of digital engagement among patients cared for in the community health center setting.

Recent studies have found language, digital comfort, and other barriers to engagement with patient portals among populations cared for in community health settings, including those whose primary language is not English.

“Thus, our findings point toward continued opportunities to engage diverse populations in the primary care setting via digital means while balancing the goal of reducing EHR burden for physicians,” the researchers pointed out.

The study also found that higher levels of team contribution on orders were linked to significantly lower total EHR time, pajama time, and time on the electronic inbox per visit.

Specifically, an above-average percentage of teamwork on orders was associated with 3.81 fewer minutes on the EHR per visit for PCPs. Additionally, PCPs that had a clinic pharmacy technician on staff spent 7.87 fewer minutes on the EHR per visit than PCPs that did not have a pharmacy technician.

The study authors noted that these associations were present even after controlling for the presence of staffing ratios.

Prior studies have described how team-based primary care workflows enhance clinical outcomes and experiences of care provision for clinicians and other team members. 

“Our findings emphasize that processes that enhance the contributions of other team members to EHR-based workflows may be particularly beneficial for optimizing EHR time,” the researchers wrote.

Additionally, the study authors noted that their findings reveal potential areas for investment to enhance EHR-related staff support. Pharmacy technicians could help reduce EHR time in multiple categories by troubleshooting medication fill issues and helping physicians with prior authorizations.

On the individual physician level, the study identified a significant, positive association between PCP years since residency and total EHR time and pajama time per visit.

This association could be due to PCPs with more years of experience conducting longer visits with patients they know well or differences in PCPs’ ability with technology.

Meanwhile, in comparison to other research, the study’s adjusted models did not find an association between PCP sex and EHR time outcomes despite associations in univariate analyses.

“Consistent with literature showing differences in clinic and EHR-related resource availability for female physicians and patients’ interactions with female physicians, our results suggest that sex differences in EHR time may be influenced by panel, clinic, or team collaboration factors rather than being solely the result of PCP sex,” the authors wrote.