HCIS 140 Week 3 EHRs in Play Example

Six Hours at the Keyboard: How an Electronic Health Record Shapes a Primary Care Workday, the Patient Portal and What Practices Can Change

[Student Name]

University of Phoenix

HCIS/140: Fundamentals of Electronic Health Records

Week 3 Assignment

[Instructor Name]

[Date]

The practice, the physician and the changes described are composites written for a model paper; research findings come from the sources listed.

Dr. Alvarez, a composite family physician, arrives at 7:30 a.m. and opens her electronic inbox: 47 items, including lab results, refill requests, patient portal messages and notes from specialists. By the time her first patient arrives at 8:00, she has cleared half of them. Her day, like that of many primary care physicians, is shaped by the electronic health record as much as by her patients. This paper follows her day, compares it with national research, looks at the patient portal and considers what her practice can change.

Previsit Review

Before each visit she scans the chart: problem list, medications, recent results and notes from other clinicians. The EHR makes this possible in minutes; with paper, outside notes often would not have arrived.

During the Visit

She sees 20 patients in a day. In the room she documents as she talks, turning partly toward the screen. She places orders for labs and referrals, reconciles medications and responds to alerts, such as a warning about a drug interaction and a reminder that a patient is due for colorectal cancer screening.

Documentation and Orders

Each visit needs a note that supports billing and quality measures. Templates help, but they also produce long notes with checkboxes. She finishes about half her notes between visits.

The National Picture

Arndt et al. (2017) measured how family physicians in one health system spent time in the EHR by combining event logs, the automatic records of every click and keystroke, with direct observation. Physicians spent 355 minutes, about 5.9 hours, of an average 11.4-hour workday in the EHR, including 86 minutes after clinic hours. Clerical and administrative tasks such as documentation, order entry, billing and coding accounted for 44% of EHR time, and inbox management for another 24%. Dr. Alvarez's day is typical rather than unusual: nearly half of a primary care physician's working hours can pass in front of the record, and a large share of that time goes to tasks that do not require a physician's training.

The Inbox

After her last patient at 4:30 p.m., she returns to 63 new inbox items. Many are portal messages from patients asking questions, requesting refills or reporting symptoms. She answers the clinical ones and forwards others to her nurse and medical assistant.

After Hours

At home, she spends about 90 minutes finishing notes and messages. She calls this pajama time. It is the part of her day most associated with burnout among her colleagues.

The Patient Portal From the Patient's Side

For patients, the portal is how they experience the EHR. They see results, visit summaries and medication lists, send messages and request appointments. Irizarry et al. (2015), reviewing research on portals, found that portals can support patient engagement, but use varies: older adults, patients with lower incomes or health literacy and some minority groups use them less, and design, training and encouragement from clinicians affect adoption. At Dr. Alvarez's practice, 58% of patients have activated portal accounts, but only 30% of patients over 75 have.

Other Users in the Same Record

The physician is not the only one working in the record. Her medical assistant rooms patients, records vital signs, reconciles medications and queues orders. The front desk schedules, registers and collects copays. The practice's nurse answers triage calls and documents advice. A coder reviews notes before claims go out and sends queries when documentation is unclear. Each of these roles has its own screens and its own burdens, and each depends on the others entering information accurately. When the medical assistant's intake is complete, the physician's note is shorter; when the physician's documentation is precise, the coder's queries disappear. Improving the EHR experience is therefore a team problem, not only a physician problem.

Alerts and Their Cost

Alerts are meant to prevent errors, but too many train people to click through them. Dr. Alvarez sees about 30 alerts a day, most of which she overrides because they do not apply. The practice's clinical informatics lead will review alert data and turn off the ones overridden more than 90% of the time.

A Different Kind of Record

Glaser (2020) argued that it is time for a new kind of electronic health record, one designed less around billing and documentation requirements and more around what clinicians and patients need to do, using modern software design. Whether or not such a record arrives soon, the argument helps explain why current systems feel built for payers.

What the Practice Can Change

Five changes are within reach. First, team documentation: medical assistants enter history, medication reconciliation and orders under protocol so the physician reviews rather than types. Second, inbox rules: normal results with standard messages go to nurses, and refill requests follow a protocol that staff can complete. Third, templates trimmed to what is needed, cutting note length. Fourth, portal support: staff help older patients activate accounts and set expectations that messages are answered within one business day. Fifth, protected time: one half-hour each day on the schedule for inbox work, so it does not spill into evenings.

Measuring Time Given Back

The practice will use the EHR's own event log reports to track total EHR time, after-hours time and inbox volume per physician before and three months after the changes, and will survey physicians and staff on workload.

Benefits Worth Keeping

The burden is real, but so are the benefits. Results arrive faster, outside records are visible, prescriptions are legible and drug interactions are caught. The goal is not to abandon the EHR but to make it work for the people using it.

Conclusion

Electronic health records in play shape almost every hour of a primary care day, with measured time of nearly six hours and much of it clerical. Patients meet the record through portals that help some and leave others behind. Team documentation, inbox rules, trimmed templates, portal support and protected time can return hours to clinicians while keeping the record's benefits.

References

Arndt, B. G., Beasley, J. W., Watkinson, M. D., Temte, J. L., Tuan, W.-J., Sinsky, C. A., & Gilchrist, V. J. (2017). Tethered to the EHR: Primary care physician workload assessment using EHR event log data and time-motion observations. Annals of Family Medicine, 15(5), 419-426. https://doi.org/10.1370/afm.2121

Glaser, J. (2020). It's time for a new kind of electronic health record. Harvard Business Review Digital Articles, 2-7.

Irizarry, T., DeVito Dabbs, A., & Curran, C. R. (2015). Patient portals and patient engagement: A state of the science review. Journal of Medical Internet Research, 17(6), Article e148. https://doi.org/10.2196/jmir.4255