Observational studyJournal of the American Medical Informatics Association : JAMIA2016
The myth of standardized workflow in primary care.
Observational study in Journal of the American Medical Informatics Association : JAMIA, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 28 papers.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
28 citing papers in PubMed.
- Using patient journey mapping and provider workflows to understand process barriers to pediatric mental and behavioral health care in emergency departments.Applied ergonomics · 2025Article
- Strategies and Tools for Electronic Health Records and Physician Workflow Alignment: Protocol for a Scoping Review.JMIR research protocols · 2025Article
- Navigating the doctor-patient-AI relationship - a mixed-methods study of physician attitudes toward artificial intelligence in primary care.BMC primary care · 2024Article
- Small Changes in Patient Arrival and Consultation Times Have Large Effects on Patients' Waiting Times: Simulation Analyses for Primary Care.International journal of environmental research and public health · 2023Article
- Determinants for scalable adoption of autonomous AI in the detection of diabetic eye disease in diverse practice types: key best practices learned through collection of real-world data.Frontiers in digital health · 2023Review
- When is caring sharing? Primary care provider interdependence and continuity of care.JAAPA : official journal of the American Academy of Physician Assistants · 2023Article
- Teaming up in primary care: Membership boundaries, interdependence, and coordination.JAAPA : official journal of the American Academy of Physician Assistants · 2022Article
- User-centered design of a scalable, electronic health record-integrated remote symptom monitoring intervention for patients with asthma and providers in primary care.Journal of the American Medical Informatics Association : JAMIA · 2021Article
- Using a Clinical Workflow Analysis to Enhance eHealth Implementation Planning: Tutorial and Case Study.JMIR mHealth and uHealth · 2021Article
- A Markov chain model for analysis of physician workflow in primary care clinics.Health care management science · 2021Article
- The Relationships Between Patient Experience and Quality and Utilization of Primary Care Services.Journal of patient experience · 2020Article
- Tailoring EHRs for Specific Working Environments Improves Work Well-Being of Physicians.International journal of environmental research and public health · 2020Article
- Impacts of Operational Failures on Primary Care Physicians' Work: A Critical Interpretive Synthesis of the Literature.Annals of family medicine · 2020Review
- The Impact of Electronic Health Records on the Duration of Patients' Visits: Time and Motion Study.JMIR medical informatics · 2020Article
- Time-motion examination of electronic health record utilization and clinician workflows indicate frequent task switching and documentation burden.AMIA ... Annual Symposium proceedings. AMIA Symposium · 2020Article
- Article
- Live Usability Testing of Two Complex Clinical Decision Support Tools: Observational Study.JMIR human factors · 2019Article
- How often do both core competencies of shared decision making occur in family medicine teaching clinics?Canadian family physician Medecin de famille canadien · 2019Article
- Designing a medication timeline for patients and physicians.Journal of the American Medical Informatics Association : JAMIA · 2019Article
- Meaningful use's benefits and burdens for US family physicians.Journal of the American Medical Informatics Association : JAMIA · 2018Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
6 authors.
Funding
Abstract
objectivePrimary care efficiency and quality are essential for the nation's health. The demands on primary care physicians (PCPs) are increasing as healthcare becomes more complex. A more complete understanding of PCP workflow variation is needed to guide future healthcare redesigns.
methodsThis analysis evaluates workflow variation in terms of the sequence of tasks performed during patient visits. Two patient visits from 10 PCPs from 10 different United States Midwestern primary care clinics were analyzed to determine physician workflow. Tasks and the progressive sequence of those tasks were observed, documented, and coded by task category using a PCP task list. Variations in the sequence and prevalence of tasks at each stage of the primary care visit were assessed considering the physician, the patient, the visit's progression, and the presence of an electronic health record (EHR) at the clinic.
resultsPCP workflow during patient visits varies significantly, even for an individual physician, with no single or even common workflow pattern being present. The prevalence of specific tasks shifts significantly as primary care visits progress to their conclusion but, notably, PCPs collect patient information throughout the visit. DISCUSSION: PCP workflows were unpredictable during face-to-face patient visits. Workflow emerges as the result of a "dance" between physician and patient as their separate agendas are addressed, a side effect of patient-centered practice.
conclusionsFuture healthcare redesigns should support a wide variety of task sequences to deliver high-quality primary care. The development of tools such as electronic health records must be based on the realities of primary care visits if they are to successfully support a PCP's mental and physical work, resulting in effective, safe, and efficient primary care.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.