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

Abstract

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.

Using Existing Clinical Information Models for Dutch Quality Registries to Reuse Data and Follow COUMT Paradigm

“…43 Structured and standardized reporting and documentation is preferred when reuse of data is desirable. Research has shown that structured documentation can improve provider efficiency, decrease documentation time, 44 and increases the quality of notes in the EHR. 45 The adoption of structured reporting by health care professionals is related to usability and compliance to the clinical pathway and the workflow.…”

Electronic Health Record Use and Perceptions among Urologic Surgeons

“…31 Prior time-motion studies involving orthopedic and head and neck surgeons showed that physicians spend one-third of their inroom time with patients on EHR tasks while an EHR log study found that academic surgeons spend 14 h/wk in the EHR. [20][21][22] Although less than primary care and medical physicians, surgeons may be particularly pressed due to time spent in the operating room. 19 settings compared to 26 to 31% for nonsurgeons.…”

“…Prior studies have characterized differences in EHR adoption among nonsurgical and surgical specialties and differences in time and usage patterns. 9,[15][16][17][18][19][20][21][22][23] Very few though have investigated surgeon perceptions of the EHR or the underlying reasons (e.g., clinical practice, culture) for their experience. 24,25 Objective Therefore, efforts to improve quality and efficiency in surgery through the EHR require greater contextual detail.…”

Clicking Away to Capture Cancer Staging—The Benefits and Challenges of Completing Standardized Staging Modules

“…11 Even within direct patient encounters, 37% of time was spent on EHR and desk work, and 1-2 hours of additional EHR work was conducted after hours 11 ; similar findings have been observed by other authors. 12 The downside of staging modules is that they add more EHR work in this context where physicians are already spending a significant portion of their time with the EHR, which ultimately translates to less time available for direct patient care. Again, time spent conducting clerical tasks has been associated with greater physician burnout.…”