The role of organizations in shaping physician use of electronic health records.

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Citation: Health Services Research. 2023 Jul 12PMID: 37438938Institution: MedStar Health Research InstituteForm of publication: Journal ArticleMedline article type(s): Journal ArticleSubject headings: IN PROCESS -- NOT YET INDEXED | Year: 2023ISSN:
  • 0017-9124
Name of journal: Health services researchAbstract: CONCLUSIONS: Results suggest unrealized opportunities for organizations and policymakers to support consistency in how physicians engage in EHR-supported work. Copyright © 2023 The Authors. Health Services Research published by Wiley Periodicals LLC on behalf of Health Research and Educational Trust.DATA COLLECTION: Extraction from Epic's Signal platform used for measuring provider EHR efficiency.DATA SOURCES: EHR metadata capturing averaged weekly measures of EHR time and documentation composition from 75,124 US primary care physicians across 299 organizations between September 2020 and May 2021 were taken. EHR time measures include active time in orders, chart review, notes, messaging, time spent outside of scheduled hours, and total EHR time. Documentation composition measures include note length and percentage use of templated text or copy/paste. Efficiency is measured as the percent of visits with same-day note completion.OBJECTIVE: The aim of the study was to (1) characterize organizational differences in primary care physicians' electronic health record (EHR) behavior; (2) assess within-organization consistency in EHR behaviors; and (3) identify whether organizational consistency is associated with physician-level efficiency.PRINCIPAL FINDINGS: EHR time per visit for physicians at a 90th percentile organization is 1.94 times the average EHR time at a 10th percentile organization. There is little evidence, on average, of an organizational signature. However, physicians in organizations with high internal consistency in EHR use demonstrate increased efficiency. Physicians in organizations with the highest internal consistency (top quartile) have a 3.77 percentage point higher same-day visit closure rates compared with peers in bottom quartile organizations (95% confidence interval: 0.0142-0.0612).STUDY DESIGN: All analyses are cross-sectional. Across-organization differences in EHR use and documentation composition are presented via 90th-to-10th percentile ratios of means and SDs. Multilevel modeling with post-estimation variance partitioning assesses the extent of an organizational signature-the proportion of variation in our measures attributable to organizations (versus specialty and individual behaviors). We measured organizational internal consistency for each measure via organization-level SD, which we grouped into quartiles for regression. Association between internally consistent (i.e., low SD) organizational EHR use and physician-level efficiency was assessed with multi-variable OLS models.All authors: Apathy NC, Cross DA, Holmgren AJFiscal year: FY2024Digital Object Identifier: ORCID: Date added to catalog: 2023-08-15
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CONCLUSIONS: Results suggest unrealized opportunities for organizations and policymakers to support consistency in how physicians engage in EHR-supported work. Copyright © 2023 The Authors. Health Services Research published by Wiley Periodicals LLC on behalf of Health Research and Educational Trust.

DATA COLLECTION: Extraction from Epic's Signal platform used for measuring provider EHR efficiency.

DATA SOURCES: EHR metadata capturing averaged weekly measures of EHR time and documentation composition from 75,124 US primary care physicians across 299 organizations between September 2020 and May 2021 were taken. EHR time measures include active time in orders, chart review, notes, messaging, time spent outside of scheduled hours, and total EHR time. Documentation composition measures include note length and percentage use of templated text or copy/paste. Efficiency is measured as the percent of visits with same-day note completion.

OBJECTIVE: The aim of the study was to (1) characterize organizational differences in primary care physicians' electronic health record (EHR) behavior; (2) assess within-organization consistency in EHR behaviors; and (3) identify whether organizational consistency is associated with physician-level efficiency.

PRINCIPAL FINDINGS: EHR time per visit for physicians at a 90th percentile organization is 1.94 times the average EHR time at a 10th percentile organization. There is little evidence, on average, of an organizational signature. However, physicians in organizations with high internal consistency in EHR use demonstrate increased efficiency. Physicians in organizations with the highest internal consistency (top quartile) have a 3.77 percentage point higher same-day visit closure rates compared with peers in bottom quartile organizations (95% confidence interval: 0.0142-0.0612).

STUDY DESIGN: All analyses are cross-sectional. Across-organization differences in EHR use and documentation composition are presented via 90th-to-10th percentile ratios of means and SDs. Multilevel modeling with post-estimation variance partitioning assesses the extent of an organizational signature-the proportion of variation in our measures attributable to organizations (versus specialty and individual behaviors). We measured organizational internal consistency for each measure via organization-level SD, which we grouped into quartiles for regression. Association between internally consistent (i.e., low SD) organizational EHR use and physician-level efficiency was assessed with multi-variable OLS models.

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