EHR audit files can be used to study workflow, patient wait times

Electronic health records

Electronic health record audit files can help analyze how a patient’s time is spent during an office visit, according to a new study in the Journal of the American Medical Informatics Association (JAMIA).

EHR audit files are generally used for data security and privacy management. However, since they provide automatic time stamped data, they can also track activity in the EHR and document EHR related transactions. That makes them a “valuable resource” to understand how time is used, according to the study's authors.

The researchers used data from 36,437 primary care encounters in 26 of Geisinger Health System's primary care clinics. They found that an adult office visit took an average of 54.6 minutes. Of that, a patient spent 45 percent of that time waiting, either in the waiting room or the exam room without a nurse or physician. The average time with a nurse was 5 minutes; the average time with a doctor was 15.5 minutes. About 9 minutes was spent in preparation, checking out and similar activities.

The researchers also found that the time spent with a patient varied somewhat. The total time was greater for older patients, those with higher level visits and those with specific diseases. Women had longer times waiting at clinicians. Not surprisingly, patients who checked in later than their scheduled appointment time spent less time in the waiting room and less time with clinicians.

“The ability to study EHR audit data retrospectively makes this low-cost method of workflow analysis uniquely suited to evaluating the rapid changes in operations and health policy. The longitudinal data available in an organization’s audit files allow for the comparison of workflow, wait time and provider face-time before and after a range of changes, from the expansion of clinic hours to changes in Medicare reimbursement," the autors write.

They go on to say that more traditional workflow analysis requires a "prospective study design and advanced notice of pending policy changes in order to evaluate the impact of these changes." They add that as hospitals try to naviagte health reform, those types of studies are "generally not feasible."

To learn more: 
- here's the study abstract