Characterizing Multitasking and Workflow Fragmentation in Electronic Health Records among Emergency Department Clinicians: Using Time-Motion Data to Understand Documentation Burden

Moy, Amanda J.; Aaron, Lucy; Cato, Kenrick; Schwartz, James H.; Elias, Jonathan; Trepp, Richard; Rossetti, Sarah Collins

doi:10.1055/s-0041-1736625

Cited by 21 publications

(29 citation statements)

References 35 publications

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“…While this is common practice, a high level of multitasking adds to the experienced documentation burden. 17 22 …”

Section: Discussionmentioning

confidence: 99%

“…Furthermore, streamlining workflow and aligning the documentation process with clinical workflow might also be effective in reducing the documentation burden. 22 26 Lindsay and Lytle found that this can result in an 18.5% reduction in documentation time. 26 Minimizing interruptions of workflow, for example, by being critical of which decision support alerts should and which should not be used, can also contribute to reducing the burden.…”

Section: Discussionmentioning

confidence: 99%

“…While this is common practice, a high level of multitasking adds to the experienced documentation burden. 17,22 Health care providers mainly had concerns regarding the available time for recording data, timely sending referral information, and finding relevant information within the EHR. All of these factors can contribute to spending additional time on the EHR and therefore cannot be spent on direct patient care.…”

Section: Comparison With Previous Literature and Interpretationmentioning

confidence: 99%

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Quantifying the Electronic Health Record Burden in Head and Neck Cancer Care

Ebbers

Kool²,

Smeele

et al. 2022

Appl Clin Inform

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Background Although the main task of health care providers is to provide patient care, studies show that increasing amounts of time are spent on documentation. Objective To quantify the time and effort spent on the electronic health record (EHR) in head and neck cancer care. Methods Cross-sectional time–motion study. Primary outcomes were the percentages of time spent on the EHR and the three main tasks (chart review, input, placing orders), number of mouse events, and keystrokes per consultation. Secondary outcome measures were perceptions of health care providers regarding EHR documentation and satisfaction. Results In total, 44.0% of initial oncological consultation (IOC) duration and 30.7% of follow-up consultation (FUC) duration are spent on EHR tasks. During 80.0% of an IOC and 67.9% of a FUC, the patient and provider were actively communicating. Providers required 593 mouse events and 1,664 keystrokes per IOC and 140 mouse events and 597 keystrokes per FUC, indicating almost 13 mouse clicks and close to 40 keystrokes for every minute of consultation time. Less than a quarter of providers indicated that there is enough time for documentation. Conclusion This study quantifies the widespread concern of high documentation burden for health care providers in oncology, which has been related to burnout and a decrease of patient–clinician interaction. Despite excessive time and effort spent on the EHR, health care providers still felt this was insufficient for proper documentation. However, the need for accurate and complete documentation is high, as reuse of information becomes increasingly important. The challenge is to decrease the documentation burden while increasing the quality of EHR data.

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“…While this is common practice, a high level of multitasking adds to the experienced documentation burden. 17 22 …”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Comparison With Previous Literature and Interpretationmentioning

confidence: 99%

See 1 more Smart Citation

Quantifying the Electronic Health Record Burden in Head and Neck Cancer Care

Ebbers

Kool²,

Smeele

et al. 2022

Appl Clin Inform

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“…Breaks in attention within each of these two units increase clinicians' cognitive workload, which in turn contributes to burnout. 6 7 8 9 10 11 12 The two interactions impede each other, with EHR tasks and direct patient contact typically overlapping.…”

Section: Cognitive Overload—a Situation Where Undivided Attention Is ...mentioning

confidence: 99%

Measuring and Maximizing Undivided Attention in the Context of Electronic Health Records

2022

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“…6 An ever important consideration when designing decision support tools is the potential burden that such tools can place on clinicians when improperly designed. [7][8][9] User-centered design techniques applied from the design stage can mitigate some of this burden. 10,11…”

Section: Available Knowledge and Knowledge Gapsmentioning

confidence: 99%

Decision Support to Improve Critical Care Services Documentation in an Academic Emergency Department

et al. 2022

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Objectives Critical care services (CCS) documentation affects billing, operations, and research. No studies exist on documentation decision support (DDS) for CCS in the emergency department (ED). We describe the design, implementation, and evaluation of a DDS tool built to improve CCS documentation at an academic ED. Methods This quality improvement study reports the prospective design, implementation, and evaluation of a novel documentation decision support tool for CCS documentation at an academic ED. CCS-associated ED diagnoses triggered a message to appear within the physician note attestation workflow for any patient seen in the adult ED. The alert raised awareness of CCS-associated diagnoses without recommending specific documentation practices. The message disappeared from the note automatically once signed. We measured CPT codes 99291 or 99292 (representing CCS rendered) for 8 months before and after deployment to identify CCS documentation rates. We performed state-space Bayesian time-series analysis to evaluate the causal effect of our intervention on CCS documentation capture. We used monthly ED volume and monthly admission rates as covariate time-series for model generation. Results The study included 92,350 ED patients with an observed mean proportion CCS of 3.9% before the intervention and 5.8% afterwards. The counterfactual model predicted an average response of 3.9% [95% CI 3.5 – 4.3%]. The estimated absolute causal effect of the intervention was 2.0% [95% CI 1.5 – 2.4%] (p = 0.001). Conclusions A DDS tool measurably increased ED CCS documentation. Attention to user workflows and collaboration with compliance and billing teams avoided alert fatigue and ensures compliance.

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Characterizing Multitasking and Workflow Fragmentation in Electronic Health Records among Emergency Department Clinicians: Using Time-Motion Data to Understand Documentation Burden

Cited by 21 publications

References 35 publications

Quantifying the Electronic Health Record Burden in Head and Neck Cancer Care

Quantifying the Electronic Health Record Burden in Head and Neck Cancer Care

Measuring and Maximizing Undivided Attention in the Context of Electronic Health Records

Decision Support to Improve Critical Care Services Documentation in an Academic Emergency Department

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