Recent Highlights

with Lisa Rotenstein, David Bates, and A Jay Holmgren in Health Services Research

We used EHR usage data for more than 200,000 US ambulatory physicians to examine the relationship between characteristics of clinical notes and outcomes capturing both documentation burden and physician efficiency. We found that physicians with the longest notes spent 39% more time in the EHR after hours than physicians at the median of note length. Top-decile note writers also closed 5.9 percentage points fewer visits on the same day. Templated text (e.g., Epic's SmartTools) demonstrated a non-linear relationship with burden and efficiency, with very low and very high levels of use associated with increased EHR burden and decreased efficiency.

with Dori Cross, Allison Hare, and Sarah Fendrich in Annals of Internal Medicine

We used weekly EHR usage data for more than 300,000 US ambulatory providers to estimate the impacts of the 2021 CMS/AMA Evaluation & Management code guideline change that reduced documentation requirements and simplified criteria for justifying E/M billing codes. We found dramatic immediate shifts upwards in E/M code mix, with the largest changes concentrated in procedural specialties, but no changes in documentation length or the amount of time providers spent authoring notes, suggesting that the change only achieved one of its two stated goals (to simplify billing and reduce documentation burden).

with A Jay Holmgren and Rachel Werner in The American Journal of Managed Care

We used 4 years of hospital survey data coupled with novel difference-in-difference analysis techniques to explore hospital health information exchange networks before and after joining ACOs. We found that joining an ACO increases the breadth of a hospital's HIE network by 30.7%, with larger effects for hospitals in markets with high existing ACO penetration. Hospitals in these markets were also able to expand networks more quickly than hospitals in markets with fewer other ACO participants.

Peer Reviewed Journal Articles

Rule, A; Kannampallil, T; Hribar, MR; Dziorny, AC; Thombley, R; Apathy, NC; Adler-Milstein. J. Guidance For Reporting Analyses of Metadata on Electronic Health Record Use. Journal of the American Medical Informatics Association. 20 December 2023.

Milicia, AP; Handley, JL; Boxley, CL; Busog, DNC; Krevat, S; Apathy, NC; Marchalik, D; Ratwani, RM; Franklin, ES. Are They Aligned? An Analysis of Social Media-Based Nurse Well-Being Concerns and Well-Being Programs. Patient Safety. 2023;5(3):88305.

Levy, DR; Moy, AJ; Apathy, NC; Adler-Milstein, J; Rotenstein, L; Nath, B; Rosenbloom, ST; Kannampallil, T; Mishuris, RG; Alexanian, A; Sieja, A; Hribar, MR; Patel, JS; Sinsky, CA; Melnick, ER. Identifying and Addressing Barriers to Implementing Core EHR Use Metrics for Ambulatory Care: Virtual Consensus Conference Proceedings. Applied Clinical Informatics. 2023;14(5).

Templeton, ZS; Apathy, NC; Konetzka RT; Skira M; Werner RM. The Health Effects of Nursing Home Specialization in Post-Acute Care. Journal of Health Economics. 2023;92:102823.

Mazurenko, O; McCord, E; McDonnell, C; Apathy, NC; Sanner, LM; Adams, MCB; Mamlin, B; Vest, JR; Hurley, RW; Harle, CA. Examining primary care provider experiences with using a clinical decision support tool for pain management. JAMIA Open. 2023;6(3).

Cross, DA; Holmgren, AJ; Apathy, NC. The Role of Organizations in Shaping Physician Use of Electronic Health Records. Health Services Research. 2023.

Apathy, NC; Dixit, R; Boxley, C; Adams, K; Booker, E; Ratwani, RM. Variations in Physician Telemedicine Provision. JAMA Network Open. 2023;6(7).

Rotenstein, LR; Apathy, NC; Edgman-Levitan, S; Landon, B. Comparison of Work Patterns Between Physicians and Advanced Practice Practitioners in Primary Care and Specialty Practice Settings. JAMA Network Open. 2023;6(6).

Apathy, NC; Rotenstein, LR; Bates, DW; Holmgren, AJ. Documentation dynamics: Note composition, burden, and physician efficiency. Health Services Research. 2022.

Holmgren, AJ; Apathy, NC. Trends in US Hospital Electronic Health Record Vendor Market Concentration, 2012 – 2021. Journal of General Internal Medicine. 2022.

Apathy, NC; Hare, AJ; Fendrich, S; Cross DA. I Had Not Time to Make it Shorter: An exploratory analysis of how physicians reduce note length and time in notes. Journal of the American Medical Informatics Association. 2022.

Rotenstein, LR; Apathy, NC; Holmgren, AJ; Bates, DW. Physician Note Composition Patterns and Time on the EHR Across Specialty Types: A National, Cross-Sectional Study. Journal of General Internal Medicine. 2022.

Rule, A; Melnick, ER; Apathy, NC. Using Event Logs to Observe Interactions with Electronic Health Records: An Updated Scoping Review Shows Increasing Use of Vendor-Derived Measures. Journal of the American Medical Informatics Association. 2022.

Apathy, NC; Howe, JL; Krevat, SA; Hettinger, AZ; Bates, DW; Classen, D; Ratwani, RM. Federal Electronic Health Record Legal Settlements Since the HITECH Act. JAMA Health Forum. 2022.

Apathy, NC; Sanner, LM; Adams, MCB; Mamlin, B; Grout, R; Fortin, S; Hillstrom, J; Saha, A; Teal, E; Vest, JR; Menachemi, N; Hurley, RW; Harle, CA; Mazurenko, O. Assessing the use of a clinical decision support tool for pain management in primary care. JAMIA Open. 2022;5(3).

Holmgren, AJ; Apathy, NC. Assessing the Impact of Patient Access to Electronic Health Information on Clinician Electronic Health Record Documentation. Journal of the American Medical Informatics Association. 2022;29(10).

Rotenstein, LR; Apathy, NC; Bates, DW; Landon, B. Variation in Support for Documentation Among Primary Care Physicians by Gender. Journal of the American Board of Family Medicine. 2022;35(4)

Mazurenko, O; Sanner, LM; Apathy, NC; Mamlin, BW; Menachemi, N; Adams, MCB; Hurley, RW; Fortin-Erazo, S; Harle, CA. Evaluation of electronic recruitment efforts of primary care providers as research subjects during the COVID-19 pandemic. BMC Primary Care. 2022;23(95).

Rotenstein, LR; Apathy, NC; Landon, B; Bates, DW. Satisfaction with the Electronic Health Record Among Physicians in Physician-Owned vs Non-Physician Owned Practices. JAMA Network Open. April 2022.

Apathy, NC; Hare, AJ; Fendrich, S; Cross DA. Early Changes in Billing and Notes after the Evaluation and Management Guideline Change. Annals of Internal Medicine. Feb 2022.

Apathy, NC; Holmgren, AJ; Werner, RM. Growth in health information exchange with ACO market penetration. American Journal of Managed Care. 2022;28(1).

Werner, RM; Templeton, Z; Apathy, NC; Skira, MM; Konetzka, RT. Trends in post-acute care in US nursing homes: 2001 to 2017. Journal of the American Medical Directors Association. 2021;22(12).

Apathy, NC; Holmgren, AJ; Adler-Milstein, J. A Decade Post-HITECH: Critical Access Hospitals have EHRs but Struggle to Keep Up with Other Advanced Functions. Journal of the American Medical Informatics Association. 2021;28(9).

Apathy, NC; Vest, JR; Adler-Milstein, J; Blackburn, J; Harle, CA. Practice and market factors associated with provider volume of health information exchange. Journal of the American Medical Informatics Association. 2021 March.

Baxter, SL; Apathy, NC; Cross, DA; Sinsky, C; Hribar, ME. Measures of electronic health record use in outpatient settings across vendors. Journal of the American Medical Informatics Association. 2020 Nov.

Taylor, HL; Apathy, NC; Vest, JR. Health information exchange use during dental visits. AMIA Annual Symposium Proceedings. 2020 Nov. Student Paper Competition Finalist

Apathy, NC; Everson, J. High rates of partial participation in the first year of the Merit-Based Incentive Program. Health Affairs. 2020 Sept.

Apathy, NC; Harle, CA; Vest, JR; Morea, JG; Menachemi, N. Use of Electronic Health Records on Days Off: Comparing Physicians to Other EHR Users. J Gen Intern Med. 2020 Aug.

Holmgren, AJ; Apathy, NC; Adler-Milstein, J. Barriers to Hospital Public Health Reporting and Implications for the COVID-19 Pandemic. Journal of the American Medical Informatics Association. 2020 May.

Holmgren, AJ; Apathy, NC. Evaluation of Prescription Drug Monitoring Program Integration With Hospital Electronic Health Records by US County-Level Opioid Prescribing Rates. JAMA Network Open. 2020 Jun 1;3(6).

Apathy, NC; Holmgren, AJ. Opt-in consent policies: potential barriers to hospital health information exchange. American Journal of Managed Care. 2020;26(1).

Holmgren, AJ; Apathy, NC. Hospital adoption of API-enabled patient data access. Healthcare: The Journal of Delivery Science and Innovation. 2019;8.

Balio, CP; Apathy, NC; Danek, R. Health information technology and accountable care organizations: synthesis of the literature and future directions. eGEMs (Generating Evidence & Methods to improve patient outcomes). 2019;7(1):24.

Apathy, NC; Yeager, VA. Examining training motivations among public health workers. Journal of Public Health Management and Practice. 2019 Vol 25 Special Supplement 2. PH WINS 2017.

Harle, CA; Apathy, NC; Cook, RL; Danielson, EC; DiIulio, J; Downs, SM; Hurley, RW; Mamlin, BW; Militello, LG; Anders, S. Information Needs and Requirements for Decision Support in Primary Care: An Analysis of Chronic Pain Care. AMIA Annual Symposium Proceedings. 2018 Nov 3-7.

Apathy, NC; Menser, T; Keeran, L; Ford, EW; Harle, CA; Huerta, TR. Trends and gaps in awareness of direct-to-consumer genetic tests from 2007-2014. American Journal of Preventive Medicine. 2018 Jun 1;54(6):806-13.

Mosa, AS; Yoo, I; Apathy, NC; Ko, KJ; Parker, JC. Secondary Use of Clinical Data to Enable Data-Driven Translational Science with Trustworthy Access Management. Missouri Medicine. 2015;112(6):443-448.