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

Khairat, Saif; Zalla, Lauren C; Gartland, Allie; Seashore, Carl

doi:10.3389/fdgth.2021.689646

Cited by 7 publications

(15 citation statements)

References 24 publications

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“… 75 , 93 , 94 , 113 Only one of the experimental studies was a randomized controlled trial. 75 Across both observational and experimental studies, 41 articles compared EHR use across different groups of users including comparisons by specialty (14 studies), 4 , 7 , 25 , 29 , 31 , 36 , 42 , 48 , 51 , 58 , 59 , 85 , 105 , 115 clinical role (12), 24 , 26 , 33 , 37 , 46 , 65 , 76 , 95 , 99 , 106 , 108 , 115 gender (8), 19 , 34 , 47 , 49 , 66 , 68 , 70 , 106 year in residency (8), 31 , 32 , 35 , 39 , 52 , 56 , 57 , 95 organization (3), 24 , 44 , 75 and country (1). 27 Vendor-measure studies were more likely than investigator-measure studies to make such comparisons of EHR use by user group (65% vs 25...…”

Section: Resultsmentioning

confidence: 99%

“…Looking at specific measures of EHR use reported in each study reveals additional differences, particularly regarding durations of EHR use ( Figure 4 ). Reported time-based measures included total time in the EHR (49 articles), 3 , 4 , 19 , 24–33 , 35–49 , 51–59 , 61 , 66 , 69–73 , 77 , 79 , 95 , 98 time in notes (32 articles), 3 , 4 , 7 , 19 , 24–32 , 35–38 , 40–46 , 48 , 51 , 55–58 , 79 , 109 time in inbox (23 articles), 2–4 , 19 , 24 , 25 , 27–29 , 35–38 , 42 , 43 , 45 , 47 , 48 , 51 , 61 , 62 , 70 , 71 time in chart review (23 articles), 3 , 4 , 24–27 , 29 , 31 , 32 , 35 , 36 , 40 , 42 , …”

Section: Resultsmentioning

confidence: 99%

“…Twenty-two studies reported a measure based on a set time period, of which 7 unique periods were used (5:30 pm –8:30 am and 12:30 pm –1:30 pm , 5:30 pm –7 am , 6 pm –6 am , 6 pm –7 am , 7 pm –7 am , 7 pm –8 am , and 7:30 pm –7:30 am ). 4 , 6 , 19 , 25 , 27 , 29 , 32 , 34 , 36 , 39 , 40 , 42 , 48 , 49 , 51 , 53 , 55 , 66 , 69–71 An overlapping set of 22 articles, including 9 that also reported time period-based measures, reported at least 1 measure based on clinician schedules. 4 , 6 , 19 , 27 , 28 , 30 , 34 , 37 , 38 , 40 , 41 , 43 , 44 , 47–50 , 67 , 69 , 72 , 77 , 119 These included time outside scheduled hours on days with appointments, time on days without appointments, and time after the patient checked out.…”

Section: Resultsmentioning

confidence: 99%

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Using event logs to observe interactions with electronic health records: an updated scoping review shows increasing use of vendor-derived measures

Rule

Melnick

Apathy

2022

Journal of the American Medical Informatics Association

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Objective The aim of this article is to compare the aims, measures, methods, limitations, and scope of studies that employ vendor-derived and investigator-derived measures of electronic health record (EHR) use, and to assess measure consistency across studies. Materials and Methods We searched PubMed for articles published between July 2019 and December 2021 that employed measures of EHR use derived from EHR event logs. We coded the aims, measures, methods, limitations, and scope of each article and compared articles employing vendor-derived and investigator-derived measures. Results One hundred and two articles met inclusion criteria; 40 employed vendor-derived measures, 61 employed investigator-derived measures, and 1 employed both. Studies employing vendor-derived measures were more likely than those employing investigator-derived measures to observe EHR use only in ambulatory settings (83% vs 48%, P = .002) and only by physicians or advanced practice providers (100% vs 54% of studies, P < .001). Studies employing vendor-derived measures were also more likely to measure durations of EHR use (P < .001 for 6 different activities), but definitions of measures such as time outside scheduled hours varied widely. Eight articles reported measure validation. The reported limitations of vendor-derived measures included measure transparency and availability for certain clinical settings and roles. Discussion Vendor-derived measures are increasingly used to study EHR use, but only by certain clinical roles. Although poorly validated and variously defined, both vendor- and investigator-derived measures of EHR time are widely reported. Conclusion The number of studies using event logs to observe EHR use continues to grow, but with inconsistent measure definitions and significant differences between studies that employ vendor-derived and investigator-derived measures.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

See 1 more Smart Citation

Using event logs to observe interactions with electronic health records: an updated scoping review shows increasing use of vendor-derived measures

Rule

Melnick

Apathy

2022

Journal of the American Medical Informatics Association

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“…On the contrary, the willingness of care providers to use technologies and the willingness and potential support of facility leadership were promising enablers of DHIs. The capacity and effective utilization of digital health among healthcare workers depend on their workload, time spent, and documentation length, indicating that the training methods should meet the healthcare providers' learning needs ( 35 ).…”

Section: Discussionmentioning

confidence: 99%

Capacity and Readiness Assessment of Healthcare Facilities for Digital Health Interventions Against Tuberculosis and HIV in Addis Ababa, Ethiopia

Getachew

Woldeamanuel

Manyazewal

2022

Front. Digit. Health

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BackgroundThere is a high level of concern that low-income countries lack the capacity and readiness to effectively adopt, implement, and scale up digital health interventions (DHIs). We aimed to assess the infrastructure and human resource capacity and readiness of healthcare facilities to adopt and implement any new DHI for tuberculosis (TB) and HIV care and treatment in Addis Ababa, Ethiopia.MethodWe carried out a cross-sectional, mixed-methods study in 14 public healthcare facilities that provide TB and HIV care and treatment services. Providers' perceived readiness to adopt and implement digital health was assessed using a self-administered questionnaire designed based on an adapted eHealth readiness assessment model that covers six domains: core readiness, organizational cultural readiness, value proposition readiness, technological readiness, regulatory policy readiness, and operational resource readiness. The infrastructure and human resource capacity were assessed on-site using a tool adapted from the Technology Infrastructure Checklist. Internal consistency was assessed using Cronbach's alpha, and the significant relationship between the composite variables was assessed using Pearson's correlation coefficients (r).ResultWe assessed 14 facilities on-site and surveyed 60 TB and HIV healthcare providers. According to Cronbach's alpha test, all the six technology acceptance domains had a value of >0.8, suggesting a strong interrelatedness between the measuring items. The correlation between technological readiness and operational resource readiness was significant (r = 0.8). The providers perceived their work environment as good enough in electronic data protection, while more efforts are needed in planning, training, adapting, and implementing digital health. Of the 14 facilities, 64.3% lack the plan to establish a functional local area network, and 43% lack skilled staff on payroll to provide maintenance of computers and other digital technologies.ConclusionLike many developing countries, there was a modest infrastructure and human resource capacity and readiness of public healthcare facilities in Addis Ababa, Ethiopia, to nurture and strengthen DHIs across the TB and HIV cascades of care. Technological and operational resource readiness, including funding and a Well-trained workforce, are essential for successful implementation and use of digital health against the two infectious diseases of global importance in such settings.

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“…Patient volume was assessed using number of appointments per day (number of appointments/number of scheduled days) and number of aggregate messages received per day. Signal has measures for "efficiency" developed by Epic that have been used by prior studies to study changes in physician workflow and usage patterns [11][12][13] . We included these with the understanding that they may not correlate perfectly with actual efficiency: (1) Same day visit closure rate; (2) Physician Efficiency Profile (PEP) score, which compares time the user spent in the system and expected time in the system based on workload, calculated using all other users in the system, with a higher score indicating less time spent compared to expected 11 ; (3) Proficiency score (measures frequency of use of embedded EHR efficiency tools) [12][13] ; (4) Time (minutes) spent in notes per appointment; (5) Turnaround time (days to respond to In Basket messages); and (6) Time (minutes) spent in In Basket per day.…”

Section: Accepted Manuscriptmentioning

confidence: 99%

Physician Electronic Health Record Usage as Affected by the COVID-19 Pandemic

Ruan

Beiser

et al. 2022

Appl Clin Inform

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Objectives: To utilize metrics from physician action logs to analyze volume, physician efficiency and burden as impacted by telemedicine implementation during the COVID-19 pandemic and physician characteristics such as gender, years since graduation and specialty category. Methods: We selected eleven metrics from Epic Signal, a functionality of the Epic electronic health record (EHR). Metrics measuring time spent in the EHR outside working hours were used as a correlate for burden. We performed an analysis of these metrics among active physicians at our institution across three time periods: pre-pandemic and telehealth implementation (August 2019), post-implementation of telehealth (May 2020), and follow-up (July 2020), and correlated them with physician characteristics. Results: Analysis of 495 physician showed that after the start of the pandemic, physicians overall had fewer appointments per day, higher same day visit closure rates, and spent less time writing notes in the EHR outside 7AM-7PM on patient scheduled days. Across all three time periods, male physicians had better EHR-defined “efficiency” measures and spent less time in the EHR outside working hours. Years since graduation only had modest associations with higher same day visit closure rates and appointments per day in May 2020. Specialty category was significantly associated with appointments per day and same day closure visit rates and also was a significant factor in the observed changes seen across the three time periods. Conclusion: Utilizing EHR-generated reports may provide a scalable and nonintrusive way to monitor trends in physician usage and experience to help guide health systems in increasing productivity and reducing burnout.

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

Cited by 7 publications

References 24 publications

Using event logs to observe interactions with electronic health records: an updated scoping review shows increasing use of vendor-derived measures

Using event logs to observe interactions with electronic health records: an updated scoping review shows increasing use of vendor-derived measures

Capacity and Readiness Assessment of Healthcare Facilities for Digital Health Interventions Against Tuberculosis and HIV in Addis Ababa, Ethiopia

Physician Electronic Health Record Usage as Affected by the COVID-19 Pandemic

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