Assessing the Effects of EHR Optimization Interventions in Primary Care

ABSTRACT Fifteen years after passage of the HITECH Act resulted in investment of billions of dollars into electronic health record (EHR) adoption, physicians and health system leaders face competing pressures related to the EHR. On one hand, widespread adoption of EHRs has had positive effects for patient safety and quality of care. On

the other hand, use of EHRs has significantly worsened the physician work experience, particularly for primary care physicians (PCPs). In the context of ongoing threats to both the US primary care workforce and primary care quality and sustainability, health system leaders struggle to identify interventions that contribute to

improved primary care quality while also enhancing PCPs’ EHR interactions and wellbeing. To address this gap, and in response to SEN-HS-22-011, we will evaluate the impact of three common or promising EHR-optimization interventions that are often considered and offered by health system leaders and

adopted by primary care clinics and PCPs, either individually or in combination: 1) scribes, 2) advanced team- based inbox messaging support, and 3) artificial intelligence (AI)-assisted inbox messaging support. At present, health system leaders lack robust, actionable evidence on the benefits and drawbacks of these interventions,

including their impact on patients’ quality of care and their relative cost effectiveness. Leveraging data and insights from three community-based and three academic primary care practice networks representing 800 PCPs caring for 1 million patients at 210 practice sites, we will: 1) test for associations between use of the 3

EHR-optimization interventions, individually or in combination, with PCPs’ EHR time and wellbeing, and patient-panel level quality of care and utilization of care; 2) describe PCP and team member experiences of adopting the 3 EHR-optimization interventions and the mechanisms by which the interventions are associated

with EHR time, physician wellbeing, and quality and utilization of care; and 3) quantify the costs to health systems of implementing each of the 3 EHR-optimization interventions, either individually or in combination. This study blends quantitative, qualitative, and cost effectiveness methods to generate information about how

to enhance PCPs’ EHR work while maintaining or enhancing quality of care. It brings together a strong, interdisciplinary team of experts in primary care operations, quality of care, informatics, EHR activity log research, and the clinician experience to generate rigorous evidence for healthcare leaders and policymakers

regarding the impact of EHR-optimization interventions across PCP and patient outcomes. It will additionally generate evidence about the cost effectiveness of these interventions. The results of this study will guide health systems leaders towards interventions that both address EHR-based challenges negatively impacting

the PCP work experience and maximize benefits of EHRs for physicians, patients, and health systems.