Documenting or Operating: Where Is Time Spent in General Surgery Residency?

Cox, Morgan L.; Farjat, Alfredo E.; Risoli, TJ; Peskoe, Sarah B.; Goldstein, Benjamin A.; Turner, David A.; Migaly, John

doi:10.1016/j.jsurg.2018.10.010

Cited by 53 publications

(49 citation statements)

References 25 publications

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“…These findings are somewhat comparable to those of Arndt et al, as PCPs in their study spent 4.5 hours and 1.4 hours each weekday completing EHR tasks during and after hours, respectively [7]. Previous studies have reported time spent completing EHR tasks ranging from 2.4 to 5.9 hours per weekday; however, few of these studies specified if this time was during or after work hours [7-11].…”

Section: Discussionsupporting

confidence: 80%

Factors Associated With Electronic Health Record Usage Among Primary Care Physicians After Hours: Retrospective Cohort Study

et al. 2019

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BackgroundThere is limited published data on variation in physician usage of electronic health records (EHRs), particularly after hours. Research in this area could provide insight into the effects of EHR-related workload on physicians.ObjectiveThis study sought to examine factors associated with after-hours EHR usage among primary care physicians.MethodsElectronic health records usage information was collected from primary care pediatricians in a large United States hospital. Inclusion criteria consisted solely of being a primary care physician who started employment with the hospital before the study period, so all eligible primary care physicians were included without sampling. Mixed effects statistical modeling was used to investigate the effects of age, gender, workload, normal-hour usage, week to week variation, and provider-to-provider variation on the after-hour usage of EHRs.ResultsThere were a total of 3498 weekly records obtained on 50 physicians, of whom 22% were male and 78% were female. Overall, more EHR usage during normal work hours was associated with decreased usage after hours. The more work relative value units generated by physicians, the more time they spent interacting with EHRs after hours (β=.04, P<.001) and overall (ie, during normal hours and after hours) (β=.24, P<.001). Gender was associated with total usage time, with females spending more time than males (P=.03). However, this association was not observed with after-hours EHR usage. provider-to-provider variation was the largest and most dominant source of variation in after-hour EHR usage, which accounted for 52% of variance of total EHR usage.ConclusionThe present study found that there is a considerable amount of variability in EHR use among primary care physicians, which suggested that many factors influence after-hours EHR usage by physicians. However, provider-to-provider variation was the largest and most dominant source of variation in after-hours EHR usage. While the results are intuitive, future studies should consider the effect of EHR use variations on workload efficiency.

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Section: Discussionsupporting

confidence: 80%

Factors Associated With Electronic Health Record Usage Among Primary Care Physicians After Hours: Retrospective Cohort Study

et al. 2019

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“…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.…”

Section: Characteristics Of Included Studiesmentioning

confidence: 99%

Interaction Time with Electronic Health Records: A Systematic Review

et al. 2021

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Background The amount of time that health care clinicians (physicians and nurses) spend interacting with the electronic health record is not well understood. Objective This study aimed to evaluate the time that health care providers spend interacting with electronic health records (EHR). Methods Data are retrieved from Ovid MEDLINE(R) and Epub Ahead of Print, In-Process and Other Non-Indexed Citations and Daily, (Ovid) Embase, CINAHL, and SCOPUS. Study Eligibility Criteria Peer-reviewed studies that describe the use of EHR and include measurement of time either in hours, minutes, or in the percentage of a clinician's workday. Papers were written in English and published between 1990 and 2021. Participants All physicians and nurses involved in inpatient and outpatient settings. Study Appraisal and Synthesis Methods A narrative synthesis of the results, providing summaries of interaction time with EHR. The studies were rated according to Quality Assessment Tool for Studies with Diverse Designs. Results Out of 5,133 de-duplicated references identified through database searching, 18 met inclusion criteria. Most were time-motion studies (50%) that followed by logged-based analysis (44%). Most were conducted in the United States (94%) and examined a clinician workflow in the inpatient settings (83%). The average time was nearly 37% of time of their workday by physicians in both inpatient and outpatient settings and 22% of the workday by nurses in inpatient settings. The studies showed methodological heterogeneity. Conclusion This systematic review evaluates the time that health care providers spend interacting with EHR. Interaction time with EHR varies depending on clinicians' roles and clinical settings, computer systems, and users' experience. The average time spent by physicians on EHR exceeded one-third of their workday. The finding is a possible indicator that the EHR has room for usability, functionality improvement, and workflow optimization.

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“…This supports prior studies across multiple specialties, which have reported a similar disproportionate amount of EHR activity geared toward medical chart review during regular work hours. 6,7,29,30 Interestingly, this contrasts studies of daytime activities of ophthalmology attending physicians, where audit log analyses have shown that the number and percentage of notes reviewed were very low. 31 The authors of that study found that ancillary staff accessed significantly more notes than ophthalmologists.…”

Section: Discussionmentioning

confidence: 91%

Electronic Health Record Use among Ophthalmology Residents while on Call

Long

Tai-Seale

El‐Kareh

et al. 2020

Journal of Academic Ophthalmology

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Background As electronic health record (EHR) use becomes more widespread, detailed records of how users interact with the EHR, known as EHR audit logs, are being used to characterize the clinical workflows of physicians including residents. After-hours EHR use is of particular interest given its known association with physician burnout. Several studies have analyzed EHR audit logs for residents in other fields, such as internal medicine, but none thus far in ophthalmology. Here, we focused specifically on EHR use during on-call shifts outside of normal clinic hours. Methods In this retrospective study, we analyzed raw EHR audit log data from on-call shifts for 12 ophthalmology residents at a single institution over the course of a calendar year. Data were analyzed to characterize total time spent using the EHR, clinical volume, diagnoses of patients seen on call, and EHR tasks. Results Across all call shifts, the median and interquartile range (IQR) of the time spent logged into the EHR per shift were 88 and 131 minutes, respectively. The median (IQR) unique patient charts accessed per shift was 7 (9) patients. When standardized to per-hour measures, weekday evening shifts were the busiest call shifts with regard to both EHR use time and clinical volume. Total EHR use time and clinical volume were greatest in the summer months (July to September). Chart review comprised a majority (63.4%) of ophthalmology residents' on-call EHR activities. Conclusion In summary, EHR audit logs demonstrate substantial call burden for ophthalmology residents outside of regular clinic hours. These data and future studies can be used to further characterize the clinical exposure and call burden of ophthalmology residents and could potentially have broader implications in the fields of physician burnout and education policy.

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Documenting or Operating: Where Is Time Spent in General Surgery Residency?

Cited by 53 publications

References 25 publications

Factors Associated With Electronic Health Record Usage Among Primary Care Physicians After Hours: Retrospective Cohort Study

Factors Associated With Electronic Health Record Usage Among Primary Care Physicians After Hours: Retrospective Cohort Study

Interaction Time with Electronic Health Records: A Systematic Review

Electronic Health Record Use among Ophthalmology Residents while on Call

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