Analyses of electronic health records utilization in a large community hospital

Abstract

Introduction The Electronic Health Record (EHR) has become an integral component of healthcare delivery. Survey based studies have estimated that physicians spend 4-6 hours of their workday devoted to EHR. Our study was designed to use computer software to objectively obtain time spent on EHR. Methods We recorded EHR time for 248 physiciansover 2 time intervals. EHR active use was defined as more than 15 keystrokes, or 3 mouse clicks, or 1700 "mouse miles" per minute. We recorded total time and % of work hours spent on EHR, and differences in those based on seniority. Physicians reported duty hours using a standardized toolkit. Results Physicians spent 3.8 (±2) hours on EHR daily, which accounted for 37% (±17%), 41% (±14%), and 45% (±12%) of their day for all clinicians, residents, and interns, respectively. With the progression of training, there was a reduction in EHR time (all p values <0.01). During the first academic quarter, clinicians spent 38% (± 8%) of time on chart review, 17% (± 7%) on orders, 28% (±11%) on documentation (i.e. writing notes) and 17% (±7%) on other activities (i.e. physician hand-off and medication reconciliation). This pattern remained unchanged during the fourth quarter. Conclusions Physicians spend close to 40% of their work day on EHR, with interns spending the most time. There is a significant reduction in time spent on EHR with training and greater experience, although the overall amount of time spent on EHR remained high.

Interaction Time with Electronic Health Records: A Systematic Review

“…Half of all included studies (50%, n ¼ 9) were time motion or work sampling studies with direct observation techniques. [42][43][44][45][46][47][48][49][50] Other study designs were retrospective cohort and cross-sectional studies (44%, n ¼ 8) [51][52][53][54][55][56][57][58] and one descriptive qualitative study (6%, n ¼ 1). 59 Of conducted studies, 17 were done in the United States, [42][43][44][45][46][47][48][49][51][52][53][54][55][56][57][58][59] and one in Argentina.…”

“…[42][43][44][45][46][47][48][49][50] Other study designs were retrospective cohort and cross-sectional studies (44%, n ¼ 8) [51][52][53][54][55][56][57][58] and one descriptive qualitative study (6%, n ¼ 1). 59 Of conducted studies, 17 were done in the United States, [42][43][44][45][46][47][48][49][51][52][53][54][55][56][57][58][59] and one in Argentina. 50 A total of 14 studies observed physicians and/or residents (►Table 1), 43,[45][46][47][48][49][51][52][53][54][55][56][57][58] ...…”

“…59 Of conducted studies, 17 were done in the United States, [42][43][44][45][46][47][48][49][51][52][53][54][55][56][57][58][59] and one in Argentina. 50 A total of 14 studies observed physicians and/or residents (►Table 1), 43,[45][46][47][48][49][51][52][53][54][55][56][57][58] three studies observed nurses only (►Table 2), 44,50,59 and one study observed physician assistants. 42 The outcome was measured by direct observation using a tablet-based time recorder or mobile devices, [42][43][44][45][47][48][49] direct observation using a worksheet, 50 and counting mouse clicks.…”

“…42 The outcome was measured by direct observation using a tablet-based time recorder or mobile devices, [42][43][44][45][47][48][49] direct observation using a worksheet, 50 and counting mouse clicks. 46 Other measurement tools included event logging [51][52][53][54][55][56][57][58] and survey. 59 The approach that uses log tracking brought a significant advance to workflow analysis.…”

“…The majority of studies (n ¼ 15, 83.3%) took place in inpatient settings, of which 10 studies were performed in academic and tertiary centers and university hospitals, 42,43,45,49,52,53,[55][56][57][58] and five studies were conducted in community and community teaching hospitals. 44,46,47,50,59 Three studies were performed in outpatient settings.…”