Changes in Electronic Health Record Use Time and Documentation over the Course of a Decade

Goldstein, Israel; Hwang, Thomas S.; Gowrisankaran, Sowjanya; Bales, Ryan; Chiang, Michael F.; Hribar, Michelle R.

doi:10.1016/j.ophtha.2019.01.011

Cited by 21 publications

(22 citation statements)

References 38 publications

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“… 58 , 77 A majority of those studies involved single sites (77.1%) and were affiliated with an academic institution/teaching hospital (80.0%). One third used Epic systems (n = 13), 13 , 22 , 27 , 43 , 53 , 54 , 56 , 57 , 64 , 66 , 69 , 72 , 73 followed by multiple/other/unspecified (n = 12), 14 , 28 , 29 , 52 , 63 , 67 , 68 , 75–79 Cerner (n = 6), 58–60 , 65 , 71 , 74 Allscripts (n = 2), 61 , 62 and Eclipsys (n = 2). 55 , 70 …”

Section: Resultsmentioning

confidence: 99%

“…Most studies exclusively focused on physicians (n = 25) 13–2942 as compared to nurses (n = 5) 58 , 67 , 76–78 or an interprofessional sample of providers (n = 5). 22 , 55 , 56 , 69 , 73 Clinician specialties were heterogeneous; over half the studies involved single specialties (general [n = 11], 14 , 27 , 52 , 53 , 61 , 62 , 64 , 71–73 , 75 emergency [n = 2], 57 , 79 intensivist [n = 2], 67 , 70 other [(n = 5] 13 , 54 , 56 , 74 , 78 ), while the remaining were multiple subspecialties (n = 13) 9 , 22 , 28 , 43 , 58–60 , 63 , 65 , 66 , 69 , 76 , 77 or unspecified (n = 2). 55 , 68 Across all studies, most involved general medicine (n = 17) 14 , 22 , 27 , 28 , 43 , 52 , 53 , 59–66 , 69 , 71–73 , 75–77 follo...…”

Section: Resultsmentioning

confidence: 99%

“… 55 , 68 Across all studies, most involved general medicine (n = 17) 14 , 22 , 27 , 28 , 43 , 52 , 53 , 59–66 , 69 , 71–73 , 75–77 followed by surgical subspecialties (n = 8), 13 , 29 , 58 , 59 , 66 , 74 , 77 , 78 intensive care (n = 6), 58 , 59 , 67 , 70 , 76 and emergency medicine (n = 4) 57 , 58 , 60 , 79 ; 10 included other subspecialties. 22 , 28 , 29 , 54 , 56 , 58 , 60 , 63 , 65 , 66 …”

Section: Resultsmentioning

confidence: 99%

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Measurement of clinical documentation burden among physicians and nurses using electronic health records: a scoping review

Moy

Schwartz

Chen

et al. 2021

Journal of the American Medical Informatics Association

133

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Background Objective Electronic health records (EHRs) are linked with documentation burden resulting in clinician burnout. While clear classifications and validated measures of burnout exist, documentation burden remains ill-defined and inconsistently measured. We aim to conduct a scoping review focused on identifying approaches to documentation burden measurement and their characteristics. Materials and Methods Based on Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) Extension for Scoping Reviews (ScR) guidelines, we conducted a scoping review assessing MEDLINE, Embase, Web of Science, and CINAHL from inception to April 2020 for studies investigating documentation burden among physicians and nurses in ambulatory or inpatient settings. Two reviewers evaluated each potentially relevant study for inclusion/exclusion criteria. Results Of the 3482 articles retrieved, 35 studies met inclusion criteria. We identified 15 measurement characteristics, including 7 effort constructs: EHR usage and workload, clinical documentation/review, EHR work after hours and remotely, administrative tasks, cognitively cumbersome work, fragmentation of workflow, and patient interaction. We uncovered 4 time constructs: average time, proportion of time, timeliness of completion, activity rate, and 11 units of analysis. Only 45.0% of studies assessed the impact of EHRs on clinicians and/or patients and 40.0% mentioned clinician burnout . Discussion Standard and validated measures of documentation burden are lacking. While time and effort were the core concepts measured, there appears to be no consensus on the best approach nor degree of rigor to study documentation burden. Conclusion Further research is needed to reliably operationalize the concept of documentation burden, explore best practices for measurement, and standardize its use.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

See 1 more Smart Citation

Measurement of clinical documentation burden among physicians and nurses using electronic health records: a scoping review

Moy

Schwartz

Chen

et al. 2021

Journal of the American Medical Informatics Association

133

View full text Add to dashboard Cite

show abstract

“…Although EHRs can positively affect patient safety, continuity of care, and compliance with regulatory and billing requirements [4], EHR implementation is still associated with negative outcomes, with some evidence suggesting that documentation time increases as a result of EHR implementation [5]; however, it is not clear whether this effect persists over time. Moreover, one recent study conducted in ophthalmology suggests that over the course of a decade, EHR documentation time and note length increased significantly [6].…”

Section: Introductionmentioning

confidence: 99%

Influence of Scribes on Patient-Physician Communication in Primary Care Encounters: Mixed Methods Study

Danak¹,

Guetterman²,

Plegue³

et al. 2019

JMIR Med Inform

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Background With the increasing adoption of electronic health record (EHR) systems, documentation-related burdens have been increasing for health care providers. Recent estimates indicate that primary care providers spend about one-half of their workdays interacting with the EHR, of which about half is focused on clerical tasks. To reduce documentation burdens associated with the EHR, health care systems and physician practices are increasingly implementing medical scribes to assist providers with real-time documentation. Scribes are typically unlicensed paraprofessionals who assist health care providers by documenting notes electronically under the direction of a licensed practitioner or physician in real time. Despite the promise of scribes, few studies have investigated their effect on clinical encounters, particularly with regard to patient-provider communication. Objective The purpose of this quasi-experimental pilot study was to understand how scribes affect patient-physician communication in primary care clinical encounters. Methods We employed a convergent mixed methods design and included a sample of three physician-scribe pairs and 34 patients. Patients’ clinical encounters were randomly assigned to a scribe or nonscribe group. We conducted patient surveys focused on perceptions of patient-provider communication and satisfaction with encounters, video recorded clinical encounters, and conducted physician interviews about their experiences with scribes. Results Overall, the survey results revealed that patients across both arms reported very high satisfaction of communication with their physician, their physician’s use of the EHR, and their care, with very little variability. Video recording analysis supported patient survey data by demonstrating high measures of communication among physicians in both scribed and nonscribed encounters. Furthermore, video recordings revealed that the presence of scribes had very little effect on the clinical encounter. Conclusions From the patient’s perspective, scribes are an acceptable addition to clinical encounters. Although they do not have much impact on patients’ perceptions of satisfaction and their impact on the clinical encounter itself was minimal, their potential to reduce documentation-related burden on physicians is valuable. Physicians noted important issues related to scribes, including important considerations for implementing scribe programs, the role of scribes in patient interactions, how physicians work with scribes, characteristics of good scribes, and the role of scribes in physician workflow.

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“…7 In ophthalmology, the addition of the EHR has generated a variety of opinions, but it is widely known that utilizing EHRs in practice requires a significant amount of time for physicians. 5,8 One study reports that the EHR accounted for 27% of ophthalmologist's time during patient encounters, using 10.8 minutes on average per encounter and 1.9 hours per half-day clinic session. 9 The burden of the EHR on ophthalmologists specifically has been shown in several studies to have a negative impact on productivity, with an increase in documentation time but little to no increase or even reduction in clinical volume.…”

mentioning

confidence: 99%

Effect of Scribes on Efficiency in Academic Ophthalmology Practice

Furst

Chu

Wannamaker

et al. 2020

Journal of Academic Ophthalmology

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Objective The aim of the study is to determine the effects of scribes on efficiency in an academic ophthalmology practice. Design This is a quality improvement study conducted by two ophthalmologists at an academic ophthalmology practice at UT Health San Antonio from January 2018 to April 2018. Implementation of scribes in practice was the primary intervention. Session time, patient encounter time, and template time adherence were recorded pre- and post-intervention. A second retrospective arm of the study at the same institution was performed to evaluate long-term effects of scribes on efficiency in ophthalmology practice on session times and patient volume 12 to 18 months after intervention. Main Outcome Measures Primary study outcomes and measures were the effect of scribes in academic ophthalmology practice on physician efficiency in terms of clinic session time, individual encounter time, and amount of patients seen per session, in addition to time adherence based on type of patient encounter. Results Eighty-three patients and 17 half-day clinic sessions and 169 patients and 21 half-day clinic sessions were included in the preintervention and post-intervention datasets, respectively. Number of patients per session was approximately 15 and was kept similar pre- and post-intervention (p = 0.45). Mean preintervention session time was 265.0 ± 31.4 minutes, in contrast to 223.4 ± 19.9 minutes after intervention (p < 0.001). Mean preintervention patient encounter time was 15.0 ± 8.3 minutes, while the mean encounter time after intervention was 10.9 ± 7.0 minutes (p < 0.005). In a retrospective analysis of 20 clinic sessions and 438 patients 12 to 18 months after intervention, session time increased to 266.0 ± 22.0 minutes on average, but the average number of patients per session increased to 21.9 ± 2.8 minutes. Conclusion Utilizing scribes in an ophthalmology practice can increase efficiency, allowing more patients to be seen or allowing time for other activities such as teaching or research.

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Changes in Electronic Health Record Use Time and Documentation over the Course of a Decade

Cited by 21 publications

References 38 publications

Measurement of clinical documentation burden among physicians and nurses using electronic health records: a scoping review

Measurement of clinical documentation burden among physicians and nurses using electronic health records: a scoping review

Influence of Scribes on Patient-Physician Communication in Primary Care Encounters: Mixed Methods Study

Effect of Scribes on Efficiency in Academic Ophthalmology Practice

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