Quantitative ethnographic study of physician workflow and interactions with electronic health record systems

• Differences exist in the duration physicians completed workflow tasks.
• Technology centered doctors have the highest documentation time.
• Differences in workflow were related to physicians' computer use style.
• Some physicians do not document the information they gathered in the visit.

This study explores the relationship between primary care physicians' interactions with health information technology and primary care workflow. Clinical encounters were recorded with high-resolution video cameras to capture physicians' workflow and interaction with two objects of interest, the electronic health record (EHR) system, and their patient. To analyze the data, a coding scheme was developed based on a validated list of primary care tasks to define the presence or absence of a task, the time spent on each task, and the sequence of tasks. Results revealed divergent workflows and significant differences between physicians' EHR use surrounding common workflow tasks: gathering information, documenting information, and recommend/discuss treatment options. These differences suggest impacts of EHR use on primary care workflow, and capture types of workflows that can be used to inform future studies with larger sample sizes for more effective designs of EHR systems in primary care clinics. Future research on this topic and design strategies for effective health information technology in primary care are discussed.Relevance to industryThis paper presents the effect of EHR use on workflow of a primary care visit. Understanding physicians' interaction styles can inform design of specific features of future health IT systems for more effective and efficient workflow in outpatient setting.