Development of a primary care physician task list to evaluate clinic visit workflow

Journal Name: 
BMJ Qual Saf
Authors: 
Wetterneck,T.B.
Lapin,J.A.
Krueger,D.J.
Holman,G.T.
Beasley,J.W.
Karsh,B.T.
Abstract: 
BACKGROUND: Interventions designed to improve the delivery of primary care, including Patient-Centered Medical Homes and electronic health records, require an understanding of clinical workflow to be successfully implemented. However, there is a lack of tools to describe and study primary care physician workflow. We developed a comprehensive list of primary care physician tasks that occur during a face-to-face patient visit. METHODS: A validated list of tasks performed by primary care physicians during patient clinic visits was developed from a secondary data analysis of observation data from two studies evaluating primary care workflow. Thirty primary care physicians participated from a convenience sample of 17 internal medicine and family medicine clinics in Wisconsin and Iowa across rural and urban settings and community and academic settings. RESULTS: The final task list has 12 major tasks, 189 subtasks, and 191 total tasks. The major tasks are: Enter Room, Gather Information from Patient, Review Patient Information, Document Patient Information, Perform, Recommend / Discuss Treatment Options, Look Up, Order, Communicate, Print / Give Patient (advice, instructions), Appointment Wrap-up, and Leave Room. Additional subcodes note use of paper or EHR and the presence of a caregiver or medical student. CONCLUSIONS: The task list presented here is a tool that will help clinics study their workflows so they can plan for changes that will take place because of EHR implementation and/or transformation to a patient centered medical home
1
2012
Volume: 
21
Pages: 
47-53
Keywords: 
310, analysis, Checklist, clinical, community, delivery, Development, electronic, Electronic Health Records, Family, Health, Humans, information, Internal Medicine, intervention, Iowa, medical, Medicine, Methods, Observation, Office Visits, organization & administration, Paper, patient, Physicians, Physicians,Primary Care, primary care, Primary Health Care, Public Health, Record, Records, Research, Research Support, review, Standards, support, Task Performance and Analysis, tools, understanding, Wisconsin, Workflow