• A study analyzed the workflow and implementation of electronic health records (EHR) in a small physician's office across various functions. It characterized the differences in offices with varying degrees of computer support in terms of workflow, sources of delay, and barriers to implementing the entire workflow through EHR and workplace management systems.
• The study compared the workflow of specialty physicians and primary care physicians and found that specialty care physicians were more likely to support the implementation of EHR systems. While primary care physicians were overall supportive of implementing EHR systems, they often considered the barriers insurmountable. This was primarily due to the complex workflows within primary care practices that lead to non-standardized workflow structures and practices.
• When EHR systems can interact with external entities through computer transactions, they are more likely to be implemented in a primary care setting. If there is a non-standardized approach to communication with external entities, smaller primary care practices are more likely to retain a paper-based system.
• The study found that external communications occurred in a greater volume and were significantly more varied in primary care compared to specialty practices. It is easier to adopt an off the shelf system when the nature and volume of external communications are narrower.
• On average, there are two staff per physician in a primary care setting. While in a specialty setting, the physician is supported by an average of three staff members, as they are more likely to perform procedures in-house.
• There is some variation between who completes registration, billing, and organizational record-keeping. Primary physician practices more likely to have front desk staff complete these functions. In contrast, specialty practices are more likely to have a person who had specific responsibility for billing and record-keeping.
• A 2016 study found that standardized workflow is a myth in primary practice and the workflow of a primary care physician varies significantly even for an individual physician. Often there is no common workflow pattern present.
• The study describes the workflow as emerging as a result of a "dance" between the physician and the patient throughout the consultation, where specific agendas are addressed. This is attributed to the patient-centered approach to medicine at the center of primary practice.

Summary

• In our initial hour of research, we have focused on finding articles relating to the workflow at a primary care practice. While there is research in the area, it did take us some time to locate it. There is sufficient data available to develop an overview of the primary care physician's workflow. Where there is a shortfall in this data, we should be able to supplement the available information with that from specialty practices.
• There is limited data available relating to the analysis of patient data sets; however, this information could be supplemented with information from specialty practices.
• It is not uncommon, in research of this nature, to develop a psychographic profile of primary care physicians relating to technology.
• Given this, we suggest the research path set out below.