Surgery Residents Spend Nearly 8 Months of Their 5-Year Training on the Electronic Health Record (EHR)

Watson, Michael; Elhage, Sharbel A.; Green, John M.; Sachdev, Gaurav

doi:10.1016/j.jsurg.2020.06.017

Cited by 17 publications

(24 citation statements)

References 20 publications

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“…Of the 37 articles that reported durations of EHR use for specific activities such as inbox management or chart review, 2–4 , 7 , 19 , 24–32 , 35–38 , 40–48 , 51 , 55–58 , 62 , 70 , 71 , 79 , 109 16 described how actions were mapped to activities, either by providing a list of actions mapped to each activity, or by stating that the EHR vendor had done the mapping. 2–4 , 7 , 25 , 27 , 29 , 32 , 40 , 43 , 44 , 57 , 58 , 62 , 70 , 71 There was no difference in reporting between vendor-measure or investigator-measure studies (67% vs 39% of relevant articles, P = .370).…”

Section: Resultsmentioning

confidence: 94%

“… 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%

“… 2–4 , 24 , 26 , 27 , 31 , 34–36 , 38 , 40 , 41 , 43–46 , 48–50 , 52 , 54 , 55 , 59 , 62 , 66 , 69–71 , 79 , 95 The next most popular denominators were number of appointments (12 articles), 24 , 25 , 29 , 30 , 32 , 35 , 38 , 40 , 42 , 44 , 72 , 77 and patients (9 articles). 26 , 31 , 39 , 41 , 51 , 53 , 56 , 57 , 98 Eleven other denominators were also used including EHR time per hour of clinic, per 8 h of clinic, per clinic session, per shift, per week, per month, per quarter, per year, per procedure, per note, and per residency.…”

Section: Resultsmentioning

confidence: 99%

See 2 more Smart Citations

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: 94%

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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“…A number of studies suggest that physicians believe their basic, standard EHR training, typically associated with onboarding when they start their residencies, is inadequate. A recent study suggests that surgery residents spend the first 8 months of their residency becoming proficient with the EHR [17][18][19]. Residents desire more EHR-related education, which is more likely to be positively received when taught by peers [18,20].…”

Section: Introductionmentioning

confidence: 99%

The Impact of Electronic Health Record–Based Simulation During Intern Boot Camp: Interventional Study

Miller¹,

Scholl²,

Corby³

et al. 2021

JMIR Med Educ

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Background Accurate data retrieval is an essential part of patient care in the intensive care unit (ICU). The electronic health record (EHR) is the primary method for data storage and data review. We previously reported that residents participating in EHR-based simulations have varied and nonstandard approaches to finding data in the ICU, with subsequent errors in recognizing patient safety issues. We hypothesized that a novel EHR simulation-based training exercise would decrease EHR use variability among intervention interns, irrespective of prior EHR experience. Objective This study aims to understand the impact of a novel, short, high-fidelity, simulation-based EHR learning activity on the intern data gathering workflow and satisfaction. Methods A total of 72 internal medicine interns across the 2018 and 2019 academic years underwent a dedicated EHR training session as part of a week-long boot camp early in their training. We collected data on previous EHR and ICU experience for all subjects. Training consisted of 1 hour of guided review of a high-fidelity, simulated ICU patient chart focusing on best navigation practices for data retrieval. Specifically, the activity focused on using high- and low-yield data visualization screens determined by expert consensus. The intervention group interns then had 20 minutes to review a new simulated patient chart before the group review. EHR screen navigation was captured using screen recording software and compared with data from existing ICU residents performing the same task on the same medical charts (N=62). Learners were surveyed immediately and 6 months after the activity to assess satisfaction and preferred EHR screen use. Results Participants found the activity useful and enjoyable immediately and after 6 months. Intervention interns used more individual screens than reference residents (18 vs 20; P=.008), but the total number of screens used was the same (35 vs 38; P=.30). Significantly more intervention interns used the 10 most common screens (73% vs 45%; P=.001). Intervention interns used high-yield screens more often and low-yield screens less often than the reference residents, which are persistent on self-report 6 months later. Conclusions A short, high-fidelity, simulation-based learning activity focused on provider-specific data gathering was found to be enjoyable and to modify navigation patterns persistently. This suggests that workflow-specific simulation-based EHR training throughout training is of educational benefit to residents.

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“…10,11 Other studies have quantified EHR utilization during general surgery training, finding that residents spend the equivalent of 8 to 17 months using the EHR during a 5year residency. 12,13 Based on these studies, it is impossible to infer the impact on EM residency. The patient population and workflow (absence of clinic and operative time) are unique to EM and the impact of EHR use on clinical education, resident wellness, and patient care are worth examining.…”

Section: Introductionmentioning

confidence: 99%

Emergency medicine residents spend over 7.5 months of their 3‐year residency on the electronic health record

Olson

Rushnell

Khan

et al. 2021

AEM Education and Training

Self Cite

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Background: Use of the electronic health record (EHR) is a standard component of modern patient care. Although EHRs have improved since inception, cumbersome workflows decrease the time for residents to spend on clinical and educational activities. This study aims to quantify the time spent interacting with the EHR during a 3-year emergency medicine (EM) residency. Methods: System records of time spent actively engaged in EHR use were analyzed for 98 unique EM residents over a period of 5 years from July 2015 to June 2020. Time spent on the EHR was totaled to give a career time, with a "work month" defined as a 4-week period of 70.5 h per week, based on Accreditation Council for Graduate Medical Education work hour restrictions for EM residents. Engagement in specific activities such as chart review, documentation preparation, and order entry were separately analyzed. Results: Over their 3-year training, a resident interacted with the EHR for 2,171 continuous hours. This amounts to 30.8 work weeks or 7.7 work months. Chart review was the most time-intensive activity at 11.42 weeks. Documentation accounted for 9.91 weeks, with an average career total of 7,280 notes created. Additionally, each resident spent 4.57 weeks on order entry, with 46,347 orders entered during training. While the number of charts opened increased after first year of residency, average time spent on each activity per patient decreased. Conclusions: This unique study quantifies the total time an EM resident spends on the EHR during a 3-year residency. Use of the EHR accounted for over 7.5 work months or nearly 21% of their training. Residents spend a substantial portion of their training interacting with the EHR and workflow improvements to reduce EHR time are critical for maximizing training time.

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Surgery Residents Spend Nearly 8 Months of Their 5-Year Training on the Electronic Health Record (EHR)

Cited by 17 publications

References 20 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

The Impact of Electronic Health Record–Based Simulation During Intern Boot Camp: Interventional Study

Emergency medicine residents spend over 7.5 months of their 3‐year residency on the electronic health record

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