The Impact of Electronic Health Records on Time Efficiency of Physicians and Nurses: A Systematic Review

Poissant, Lise; Pereira, Jennifer A.; Tamblyn, Robyn; Kawasumi, Yuko

doi:10.1197/jamia.m1700

Cited by 720 publications

(503 citation statements)

References 52 publications

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“…Based on our small convenience sample of clinicians at these three community hospital sites, it appears that clinicians recognize that during the transition period, many work processes will take longer and that there will be some new work on their part as they become accustomed to the new system. None of our interviewees mentioned that the new system would continue to slow them down after the initial learning period (as we and others [8,19] have found at multiple CPOE implementation sites). In addition, many clinicians were worried about how they would take care of patients if/when the system went down.…”

Section: Discussion Survey Resultsmentioning

confidence: 78%

Assessing the anticipated consequences of Computer-based Provider Order Entry at three community hospitals using an open-ended, semi-structured survey instrument

Sittig¹,

Ash²,

Guappone³

et al. 2008

International Journal of Medical Informatics

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Objective-To determine what "average" clinicians in organizations that were about to implement Computer-based Provider Order Entry (CPOE) were expecting to occur, we conducted an openended, semi-structured survey at three community hospitals. Methods-We created an open-ended, semi-structured, interview survey template that we customized for each organization. This interview-based survey was designed to be administered orally to clinicians and take approximately five minutes to complete, although clinicians were allowed to discuss as many advantages or disadvantages of the impending system roll-out as they wanted to.Results-Our survey findings did not reveal any overly negative, critical, problematic, or striking sets of concerns. However, from the standpoint of unintended consequences, we found that clinicians were anticipating only a few of the events, emotions, and process changes that are likely to result from CPOE. Conclusions-The resultsof such an open-ended survey may prove useful in helping CPOE leaders to understand user perceptions and predictions about CPOE, because it can expose issues about which more communication, or discussion, is needed. Using the survey, implementation strategies and management techniques outlined in this paper, any chief information officer (CIO) or chief medical information officer (CMIO) should be able to adequately assess their organization's CPOE readiness, make the necessary mid-course corrections, and be prepared to deal with the currently identified unintended consequences of CPOE should they occur. Keywords

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Section: Discussion Survey Resultsmentioning

confidence: 78%

Assessing the anticipated consequences of Computer-based Provider Order Entry at three community hospitals using an open-ended, semi-structured survey instrument

Sittig¹,

Ash²,

Guappone³

et al. 2008

International Journal of Medical Informatics

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“…25,26 One systematic review found EHR use to be more efficient for documentation by nurses than by physicians, but did not distinguish between types of clinical settings. 10 We found no studies assessing EHR effects on the work of non-clinical staff.…”

Section: Introductionmentioning

confidence: 94%

“…Some studies point to potential EHR-related quality and safety gains due to increased adherence to guideline-based care, 1,2 more complete documentation, 3,4 and fewer medical errors. 5,6 Efficiency gains have been shown to result from electronic ordering 7,8 and from improved access to clinical information, 9,10 which can reduce redundant services. Despite these potential benefits of EHR use, research has also shown variable impact of EHR use on efficiency, and thus on the workload burdens experienced by health care workers.…”

Section: Introductionmentioning

confidence: 99%

Electronic Health Record Impact on Work Burden in Small, Unaffiliated, Community-Based Primary Care Practices

Howard¹,

Clark²,

Friedman³

et al. 2012

J GEN INTERN MED

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BACKGROUND:The use of electronic health records (EHR) is widely recommended as a means to improve the quality, safety and efficiency of US healthcare. Relatively little is known, however, about how implementation and use of this technology affects the work of clinicians and support staff who provide primary health care in small, independent practices. OBJECTIVE: To study the impact of EHR use on clinician and staff work burden in small, communitybased primary care practices. DESIGN: We conducted in-depth field research in seven community-based primary care practices. A team of field researchers spent 9-14 days over a 4-8 week period observing work in each practice, following patients through the practices, conducting interviews with key informants, and collecting documents and photographs. Field research data were coded and analyzed by a multidisciplinary research team, using a grounded theory approach. PARTICIPANTS: All practice members and selected patients in seven community-based primary care practices in the Northeastern US. KEY RESULTS: The impact of EHR use on work burden differed for clinicians compared to support staff. EHR use reduced both clerical and clinical staff work burden by improving how they check in and room patients, how they chart their work, and how they communicate with both patients and providers. In contrast, EHR use reduced some clinician work (i.e., prescribing, some lab-related tasks, and communication within the office), while increasing other work (i.e., charting, chronic disease and preventive care tasks, and some lab-related tasks). Thoughtful implementation and strategic workflow redesign can mitigate the disproportionate EHRrelated work burden for clinicians, as well as facilitate population-based care. CONCLUSIONS: The complex needs of the primary care clinician should be understood and considered as the next iteration of EHR systems are developed and implemented.KEY WORDS: electronic health records; primary care; work burden; qualitative research.

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“…Yet, one of the "problems with computers" 85 is a failure to account for the accumulated effect of small temporal disruptions on the overall performance of human systems. [85][86][87] Consider the cumulative impact of dealing with pop-up ads on the web, or spending an inordinate amount of time being shuffled from one multilayered telephone answering system to another before being connected to an advice nurse at a hospital. The error is one of myopia, argued Zuboff and Maxmin, 88 as engineers focus solutions on single transactions without considering the impact of multiple interactions on trust and relationships.…”

Section: Safetymentioning

confidence: 99%

eHealth Research from the User’s Perspective

Hesse¹,

Shneiderman²

2007

American Journal of Preventive Medicine

127

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Abstract:The application of information technology (IT) to issues of healthcare delivery has had a long and tortuous history in the United States. Within the field of eHealth, vanguard applications of advanced computing techniques, such as applications in artificial intelligence or expert systems, have languished in spite of a track record of scholarly publication and decisional accuracy. The problem is one of purpose, of asking the right questions for the science to solve. Historically, many computer science pioneers have been tempted to ask "what can the computer do?" New advances in eHealth are prompting developers to ask "what can people do?" How can eHealth take part in national goals for healthcare reform to empower relationships between healthcare professionals and patients, healthcare teams and families, and hospitals and communities to improve health equitably throughout the population? To do this, eHealth researchers must combine best evidence from the user sciences (human factors engineering, human-computer interaction, psychology, and usability) with best evidence in medicine to create transformational improvements in the quality of care that medicine offers. These improvements should follow recommendations from the Institute of Medicine to create a healthcare system that is (1) safe, (2) effective (evidence based), (3) patient centered, and (4) timely. Relying on the eHealth researcher's intuitive grasp of systems issues, improvements should be made with considerations of users and beneficiaries at the individual (patient-physician), group (family-staff), community, and broad environmental levels.(Am J Prev Med 2007;32(5S):S97-S103)

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The Impact of Electronic Health Records on Time Efficiency of Physicians and Nurses: A Systematic Review

Cited by 720 publications

References 52 publications

Assessing the anticipated consequences of Computer-based Provider Order Entry at three community hospitals using an open-ended, semi-structured survey instrument

Assessing the anticipated consequences of Computer-based Provider Order Entry at three community hospitals using an open-ended, semi-structured survey instrument

Electronic Health Record Impact on Work Burden in Small, Unaffiliated, Community-Based Primary Care Practices

eHealth Research from the User’s Perspective

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