--- title: "EHR audit file-patient-wait times. | Sutter Health" description: "Scalable ways to quantify clinical encounter workflow elements may provide the means to develop more efficient approaches to care and improve the pt. experience" url: "https://www.sutterhealth.org/research/publications/ehr-audit-file-patient-wait-times-1055312785" --- 1. [Home](https://www.sutterhealth.org/) / 2. [Research](https://www.sutterhealth.org/research) / 3. [Research publications](https://www.sutterhealth.org/research/publications) / 4. EHR audit file-patient-wait times. # The electronic health record audit file: the patient is waiting. Hirsch AG, Jones JB, Lerch VR, Tang X, Berger A, Clark DN, & Stewart WF. _J Am Med Inform Assoc. 2017 Apr 1;24(e1):e28-e34. doi: 10.1093/jamia/ocw088._ 2017-04-01 ## Abstract Objective: We describe how electronic health record (EHR) audit files can be used to understand how time is spent in primary care (PC). Materials/methods: We used audit file data from the Geisinger Clinic to quantify elements of the clinical workflow and to determine how these times vary by patient and encounter factors. We randomly selected audit file records representing 36 437 PC encounters across 26 clinic locations. Audit file data were used to estimate duration and variance of: (1) time in the waiting room, (2) nurse time with the patient, (3) time in the exam room without a nurse or physician, and (4) physician time with the patient. Multivariate modeling was used to test for differences by patient and by encounter features. Results: On average, a PC encounter took 54.6 minutes, with 5 minutes of nurse time, 15.5 minutes of physician time, and the remaining 62% of the time spent waiting to see a clinician or check out. Older age, female sex, and chronic disease were associated with longer wait times and longer time with clinicians. Level of service and numbers of medications, procedures, and lab orders were associated with longer time with clinicians. Late check-in and same-day visits were associated with shorter wait time and clinician time. Conclusions: This study provides insights on uses of audit file data for workflow analysis during PC encounters. Discussion: Scalable ways to quantify clinical encounter workflow elements may provide the means to develop more efficient approaches to care and improve the patient experience. [PubMed abstract](https://www.ncbi.nlm.nih.gov/pubmed/27375293) ![J.B. Jones, Ph.D., MBA](https://dyn.mktgcdn.com/p/rIQfkoa5XfKJYCHSVrDKsACQSNJ7jTljZTHKC4Lae2E/fit=crop,gravity=auto,dpr=2,width=188,height=250,quality=100) J.B. Jones, Ph.D., MBA Principal investigator [View profile](https://www.sutterhealth.org/research/investigators/jb-jones-phd-mba-1049680984) ## Research topics - [Health Services](https://www.sutterhealth.org/research-search-results?query=%22%5C%22Health+Services%5C%22%22) - [Medical Informatics](https://www.sutterhealth.org/research-search-results?query=%22%5C%22Medical+Informatics%5C%22%22) ## Related publications [View all publications](https://www.sutterhealth.org/research-search-results?verticalKey=research_publication) - Publication ### [Leveraging electronic health records to develop measurements for processes of care.](https://www.sutterhealth.org/research/publications/leverage-ehrs-to-measure-care-processes-1055312664) Tai-Seale M, Wilson CJ, Panattoni L, Kohli N, Stone A, Hung DY, Chung S. Health Serv Res. 49(2):628-44. doi: 10.1111/1475-6773.12126. Epub 2013 Nov 18. 2014 Apr 01 - Publication ### [Primary care physician practice styles and quality, cost, and productivity.](https://www.sutterhealth.org/research/publications/pcp-practice-styles-and-quality-cost-productivity-1055312774) Luft HS, Liang SY, Eaton LJ, Chung S. Am J Manag Care. 26(4):e127-e134. doi: 10.37765/ajmc.2020.42840. 2020 Apr 01 - Publication ### [Implementation of departmental quality strategies is positively associated with clinical practice: results of a multicenter study in 73 hospitals in 7 European countries.](https://www.sutterhealth.org/research/publications/quality-strategies-assoc-clinical-practrace-1055312466) Sunol R, Wagner C, Arah OA, Kristensen S, Pfaff H, Klazinga N, Thompson CA, Wang A, DerSarkissian M, Bartels P, Michel P, Groene O; DUQuE Project Consortium. PLoS One. 10(11):e0141157. doi: 10.1371/journal.pone.0141157. 2015 Nov 20 - Publication ### [NIH-Academia-Industry Workshop on Healthcare Intelligence Innovation.](https://www.sutterhealth.org/research/publications/nih-workshop-healthcare-intelligence-innovation-1055312779) Tai-Seale M. Carnegie Mellon University Silicon Valley campus website. 2010 Oct 04 - Publication ### [Pragmatic study of clinician use of a personalized patient decision aid integrated into the electronic health record: an 8-year experience.](https://www.sutterhealth.org/research/publications/clinician-use-of-patient-decision-aid-integrated-into-ehr-1055312641) Coylewright M, Keevil JG, Xu K, Dodge SE, Frosch D, Field ME. Telemed J E Health. doi: 10.1089/tmj.2019.0112. \[Epub ahead of print\] 2019 Aug 05 [View all publications](https://www.sutterhealth.org/research-search-results?verticalKey=research_publication) ```json {"@context":"https://schema.org","@type":"MedicalOrganization","name":"Sutter Health","@id":"https://www.sutterhealth.org/#medicalorganization","url":"https://www.sutterhealth.org","logo":"https://www.sutterhealth.org/static/images/sutter-health-logo.svg","address":{"@type":"PostalAddress","streetAddress":"2200 River Plaza Drive","addressLocality":"Sacramento","addressRegion":"CA","postalCode":"95833","addressCountry":"US"},"areaServed":{"@type":"AdministrativeArea","name":"California"},"sameAs":["https://www.facebook.com/SutterHealth","https://www.instagram.com/sutterhealth/","https://x.com/SutterHealth","https://www.youtube.com/sutterhealth","https://www.linkedin.com/company/sutter-health","https://en.wikipedia.org/wiki/Sutter_Health"]} ``` ```json {"@context":"https://schema.org","@type":"BreadcrumbList","@id":"https://www.sutterhealth.org/research/publications/ehr-audit-file-patient-wait-times-1055312785#breadcrumblist","itemListElement":[{"@type":"ListItem","position":1,"name":"Home","item":"https://www.sutterhealth.org/"},{"@type":"ListItem","position":2,"name":"Research","item":"https://www.sutterhealth.org/research"},{"@type":"ListItem","position":3,"name":"Research publications","item":"https://www.sutterhealth.org/research/publications"},{"@type":"ListItem","position":4,"name":"EHR audit file-patient-wait times."}]} ``` ```json {"@context":"https://schema.org","@type":"MedicalScholarlyArticle","@id":"https://www.sutterhealth.org/research/publications/ehr-audit-file-patient-wait-times-1055312785#medicalscholarlyarticle","name":"The electronic health record audit file: the patient is waiting.","headline":"EHR audit file-patient-wait times.","abstract":"Objective: We describe how electronic health record (EHR) audit files can be used to understand how time is spent in primary care (PC). Materials/methods: We used audit file data from the Geisinger Clinic to quantify elements of the clinical workflow and to determine how these times vary by patient and encounter factors. We randomly selected audit file records representing 36 437 PC encounters across 26 clinic locations. Audit file data were used to estimate duration and variance of: (1) time in the waiting room, (2) nurse time with the patient, (3) time in the exam room without a nurse or physician, and (4) physician time with the patient. Multivariate modeling was used to test for differences by patient and by encounter features. Results: On average, a PC encounter took 54.6 minutes, with 5 minutes of nurse time, 15.5 minutes of physician time, and the remaining 62% of the time spent waiting to see a clinician or check out. Older age, female sex, and chronic disease were associated with longer wait times and longer time with clinicians. Level of service and numbers of medications, procedures, and lab orders were associated with longer time with clinicians. Late check-in and same-day visits were associated with shorter wait time and clinician time. Conclusions: This study provides insights on uses of audit file data for workflow analysis during PC encounters. 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