Analysing EHR navigation patterns and digital workflows among physicians during ICU pre-rounds

Abstract

Background: Some physicians in intensive care units (ICUs) report that electronic health records (EHRs) can be cumbersome and disruptive to workflow. There are significant gaps in our understanding of the physician–EHR interaction. Objective: To better understand how clinicians use the EHR for chart review during ICU pre-rounds through the characterisation and description of screen navigation pathways and workflow patterns. Method: We conducted a live, direct observational study of six physician trainees performing electronic chart review during daily pre-rounds in the 30-bed medical ICU at a large academic medical centre in the Southeastern United States. A tailored checklist was used by observers for data collection. Results: We observed 52 distinct live patient chart review encounters, capturing a total of 2.7 hours of pre-rounding chart review activity by six individual physicians. Physicians reviewed an average of 8.7 patients (range = 5–12), spending a mean of 3:05 minutes per patient (range = 1:34–5:18). On average, physicians visited 6.3 (±3.1) total EHR screens per patient (range = 1–16). Four unique screens were viewed most commonly, accounting for over half (52.7%) of all screen visits: results review (17.9%), summary/overview (13.0%), flowsheet (12.7%), and the chart review tab (9.1%). Navigation pathways were highly variable, but several common screen transition patterns emerged across users. Average interrater reliability for the paired EHR observation was 80.0%. Conclusion: We observed the physician–EHR interaction during ICU pre-rounds to be brief and highly focused. Although we observed a high degree of “information sprawl” in physicians’ digital navigation, we also identified common launch points for electronic chart review, key high-traffic screens and common screen transition patterns. Implications: From the study findings, we suggest recommendations towards improved EHR design.

EMR Precharting Efficiency in Internal Medicine: A Scoping Review

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An integrative review of supportive relationships between child‐bearing women and midwives

“…Although the EHR might prompt workflows, several issues have been noted, such as ineffective time management and unexpected deficiencies in patient care and work flow (Abbey et al, 2012 ; Baumann et al, 2018 ). Thus, the effect of EHR on midwives' time needs more attention, suggesting staff training and EHR system modifications to increase the time available for women′s care (Coleman et al, 2021 ; Karp et al, 2019 ).…”

“…Thus, the effect of EHR on midwives' time needs more attention, suggesting staff training and EHR system modifications to increase the time available for women′s care (Coleman et al, 2021;Karp et al, 2019).…”

Association Between Proficiency and Efficiency in Electronic Health Records Among Pediatricians at a Major Academic Health System

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