The effect of electronic health records adoption on patient visit volume at an academic ophthalmology department

Lam, Jocelyn; Lee, Bryan S.; Chen, Philip

doi:10.1186/s12913-015-1255-8

Cited by 21 publications

(14 citation statements)

References 20 publications

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“…The decrease in clinical volume was minimal and transient; thus, the clinical outflow in the ophthalmology department was hardly affected by EHR implementation. That contrasts strikingly with previous studies reporting the opposite effect [19,20]. The ophthalmologists accepted the new EHR system, and the system utilization rate increased in relation to their satisfaction with the system.…”

Section: Discussioncontrasting

confidence: 93%

“…The ophthalmologists accepted the new EHR system, and the system utilization rate increased in relation to their satisfaction with the system. Nevertheless, most ophthalmologists still have concerns regarding the potential adverse effects on productivity and efficiency in ophthalmology practice [18,19,21]. Furthermore, a recent survey found that ophthalmologists' rate of satisfaction with their EHR has decreased [17].…”

Section: Discussionmentioning

confidence: 99%

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A Hybrid Electronic Health Record System Integrating Electronic and Paper-based Records

Terajima¹,

Negishi²,

Maruyama³

et al. 2018

ejbi

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Objectives: Ordinary electronic health record (EHR) systems have difficulty managing paper-based medical records because digitized paper-based records must be browsed with a viewer other than the main display for the EHR system. Because of this "fragmentation" of electronic and paper information, it is difficult to combine keyboard/ mouse input with handwriting input in a clinical setting. We developed a new EHR system to address this problem. Methods: We revised a commercial EHR system to function as a progress note system that integrates keyboard/ mouse-based electronic records with digitized paper-based records, both of which can be viewed in a page-turning style. In this system all records, including paper-based records, are arranged in relation to the time they were written, even when they were digitized later at a scanning center. These features of the system allow for combined use of handwritten and keyboard/mouse input, without fragmentation. We investigated the impact of the introduction of the first EHR system in the ophthalmology department at our hospital, which had long resisted implementation of an EHR system. Results: The number of ophthalmology outpatients did not significantly decrease after introduction of the system. The ophthalmologists in our hospital accepted the first EHR system without negative reactions, and a gradual transition from handwritten input to keyboard/mouse input was noted. Conclusions: The present system enables users to produce flexible medical documentation, by using both keyboard/mouse and handwriting inputs, without reducing medical efficiency or safety. This is a cost-efficient, true hybrid digital-analog EHR system.

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Section: Discussioncontrasting

confidence: 93%

Section: Discussionmentioning

confidence: 99%

A Hybrid Electronic Health Record System Integrating Electronic and Paper-based Records

Terajima¹,

Negishi²,

Maruyama³

et al. 2018

ejbi

View full text Add to dashboard Cite

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“…While EHR use is sometimes thought to lengthen clinical encounters among ophthalmologists and the field of medicine as a whole, studies examining the impact of EHR implementation on ophthalmology practices have demonstrated a mixed impact on patient volume and the time physicians spend in clinic. 5,[22][23][24][25][26][27][28] In our study, the total time that residents and fellows spent per patient encounter did not change with EHR implementation. Average time spent on a patient encounter during a paper chart-based encounter was 11.6 minutes, compared with 11.8 minutes spent on a patient encounter when using the EHR.…”

Section: Discussionmentioning

confidence: 99%

Impact of Electronic Health Record Implementation on Ophthalmology Trainee Time Expenditures

et al. 2019

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Objective Electronic health records (EHRs) are widely adopted, but the time demands of EHR use on ophthalmology trainees are not well understood. This study evaluated ophthalmology trainee time spent on clinical activities in an outpatient clinic undergoing EHR implementation. Design Prospective, manual time-motion observations of ophthalmology trainees in 2018. Participants Eleven ophthalmology residents and fellows observed during 156 patient encounters. Methods Prospective time-motion study of ophthalmology trainees 2 weeks before and 6 weeks after EHR implementation in an academic ophthalmology department. Manual time-motion observations were conducted for 11 ophthalmology trainees in 6 subspecialty clinics during 156 patient encounters. Time spent documenting, examining, and talking with patients were recorded. Factors influencing time requirements were evaluated using linear mixed effects models. Main Outcome Measures Total time spent by ophthalmology residents and fellows per patient, time spent on documentation, examination, and talking with patients. Results Seven ophthalmology residents and four ophthalmology fellows with mean (standard deviation) postgraduate year of 3.7 (1.2) were observed during 156 patient encounters. Using paper charts, mean total time spent on each patient was 11.6 (6.5) minutes, with 5.4 (3.5) minutes spent documenting (48%). After EHR implementation, mean total time spent on each patient was 11.8 (6.9) minutes, with 6.8 (4.7) minutes spent documenting (57%). Total time expenditure per patient did not significantly change after EHR implementation (+0.17 minutes, 95% confidence interval [CI] for difference in means: –2.78, 2.45; p = 0.90). Documentation time did not change significantly after EHR implementation in absolute terms (+1.42 minutes, 95% CI: –3.13, 0.29; p = 0.10), but was significantly greater as a proportion of total time (48% on paper to 57% on EHR; +9%, 95% CI: 2.17, 15.83; p = 0.011). Conclusion Total time spent per patient and absolute time spent on documentation was not significantly different whether ophthalmology trainees used paper charts or the recently implemented EHR. Percentage of total time spent on documentation increased significantly with early EHR use. Evaluating EHR impact on ophthalmology trainees may improve understanding of how trainees learn to use the EHR and may shed light on strategies to address trainee burnout.

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“…The many points of debate around electronic medical records have addressed important issues ranging from the use of decision support tools to improved access to information [2,5,6]. Some of the most important investigations regarding electronic medical records adoption have addressed the effects of electronic medical records on emergency department operations metrics, including throughput measures such as Length of stay (LOS) [4,[7][8][9].…”

Section: Introductionmentioning

confidence: 99%

Electronic medical record error in reported time of discharge: A prospective analysis at a tertiary care hospital

Pathan

Baroudi

Rahman

et al. 2020

International Journal of Healthcare Management

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Objective: The aim of the study is to evaluate the accuracy of electronic medical record reporting related to patients' length-of-stay in an emergency department. Methods: This was a prospective non-interventional study that entailed research associates observing Time of Discharge (TOD RA) in the emergency department. We used the electronic medical record to collect data in real time. The TOD RA was provided by two research associates while electronic medical record served as the source for the routinely reported length of stay data including the time of discharge in the EMR (TOD EMR). Results: A total of 184 cases for which TOD EMR and TOD RA were compared during a total of six study timing sessions. A difference of less than 5 minutes between TOD RA and TOD EMR was observed in 42.9% (79, 35.7-50.4%) and more than 5 minutes in 57.1% (105, 50.0-64.3%) of the cases. When analysis was restricted to the 105 cases where there was operationally significant (at least 5 minutes') TOD EMR error, the error direction was strongly biased toward TOD EMR 's lagging behind TOD RA. EMR-reported discharge times were usually (57% of cases) more than 5 minutes in error, and towards overestimation of the length of stay. The difference observed was clinically and operationally significant. Conclusions: In the study center, there were substantial errors in discharge time reported in the hospital's electronic medical record-sourced database. Further study is warranted to assure that the precision of EMR-reported times is matched by acceptable accuracy.

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The effect of electronic health records adoption on patient visit volume at an academic ophthalmology department

Cited by 21 publications

References 20 publications

A Hybrid Electronic Health Record System Integrating Electronic and Paper-based Records

A Hybrid Electronic Health Record System Integrating Electronic and Paper-based Records

Impact of Electronic Health Record Implementation on Ophthalmology Trainee Time Expenditures

Electronic medical record error in reported time of discharge: A prospective analysis at a tertiary care hospital

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