The impact of electronic health record systems on clinical documentation times: A systematic review

Baumann, Lisa Ann; Baker, Jannah; Elshaug, Adam G

doi:10.1016/j.healthpol.2018.05.014

Cited by 222 publications

(173 citation statements)

References 36 publications

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“…Lengthy physician notes as a result of billing, coding, and regulatory requirements, as well as conservative local interpretation of these guidelines, may contribute substantially to EHR-related work burden. 40,41 In close collaboration with local compliance experts, the team built innovative problem-based documentation workflows to reduce data entry burden and shorten note length. Providers were able to document and order all in one screen using problem-based documentation.…”

Section: Documentation Burdenmentioning

confidence: 99%

Promoting Quality Face-to-Face Communication during Ophthalmology Encounters in the Electronic Health Record Era

et al. 2020

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Objective To evaluate informatics-enabled quality improvement (QI) strategies for promoting time spent on face-to-face communication between ophthalmologists and patients. Methods This prospective study involved deploying QI strategies during implementation of an enterprise-wide vendor electronic health record (EHR) in an outpatient academic ophthalmology department. Strategies included developing single sign-on capabilities, activating mobile- and tablet-based applications, EHR personalization training, creating novel workflows for team-based orders, and promoting problem-based charting to reduce documentation burden. Timing data were collected during 648 outpatient encounters. Outcomes included total time spent by the attending ophthalmologist on the patient, time spent on documentation, time spent on examination, and time spent talking with the patient. Metrics related to documentation efficiency, use of personalization features, use of team-based orders, and note length were also measured from the EHR efficiency portal and compared with averages for ophthalmologists nationwide using the same EHR. Results Time spent on exclusive face-to-face communication with patients initially decreased with EHR implementation (2.9 to 2.3 minutes, p = 0.005) but returned to the paper baseline by 6 months (2.8 minutes, p = 0.99). Observed participants outperformed national averages of ophthalmologists using the same vendor system on documentation time per appointment, number of customized note templates, number of customized order lists, utilization of team-based orders, note length, and time spent after-hours on EHR use. Conclusion Informatics-enabled QI interventions can promote patient-centeredness and face-to-face communication in high-volume outpatient ophthalmology encounters. By employing an array of interventions, time spent exclusively talking with the patient returned to levels equivalent to paper charts by 6 months after EHR implementation. This was achieved without requiring EHR redesign, use of scribes, or excessive after-hours work. Documentation efficiency can be achieved using interventions promoting personalization and team-based workflows. Given their efficacy in preserving face-to-face physician–patient interactions, these strategies may help alleviate risk of physician burnout.

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Section: Documentation Burdenmentioning

confidence: 99%

Promoting Quality Face-to-Face Communication during Ophthalmology Encounters in the Electronic Health Record Era

et al. 2020

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“…Documenting the history 3.5 (2-5) 4.5 (4-5) 6.5 (5-8) Total 11.0 (9-13) 11.0 (9-13) 19.0 (17)(18)(19)(20)(21)(22)(23) Values are presented as median time in minutes per patient encounter (range). component of the Centers for Medicare and Medicaid Quality Payment Program.…”

Section: Findings In Contextmentioning

confidence: 99%

“…Furthermore, established medical record systems may not ease this burden. Based on data from a systematic review of 28 publications, the available record systems increased physician time spent by 16% to 28% . More specific to our field, 14% of otolaryngologists ranked their institution's electronic record system as the most challenging aspect of their job .…”

Section: Introductionmentioning

confidence: 99%

“…Based on data from a systematic review of 28 publications, the available record systems increased physician time spent by 16% to 28%. 20 More specific to our field, 14% of otolaryngologists ranked their institution's electronic record system as the most challenging aspect of their job. 16 In addition, among 19,270 physicians in all fields, the most common contributor to burnout was an excess of charting and paperwork, affecting 56% of those assessed.…”

Section: Introductionmentioning

confidence: 99%

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The Utility and Feasibility of Extending Beyond Traditional Patient Descriptions in Daily Practice

et al. 2019

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Objectives/Hypothesis Institutional and national programs have endorsed the use of validated instruments in daily practice, but their utility for frontline clinicians is unknown. Our first objective was thus to determine if routinely obtained patient descriptions accurately predict disease‐specific validated instrument results. Our second objective was to assess the feasibility of deploying an electronic system to obtain and document patient‐reported descriptions of health status. Study Design Prospective assessment of consecutive eligible ambulatory care patients. Methods For the first objective, patients presenting with the same chief complaint at consecutive visits provided concurrent routine symptom descriptions and validated instrument responses. To determine whether patients’ routine descriptions predicted scores from disease‐specific instruments, receiver operator characteristic (ROC) curves, sensitivity/specificity, Spearman ρ correlation, and regression models were utilized. For the second objective, feasibility assessment focused on percent with successful response capture, time to questionnaire completion, and impact on physician time needed to obtain and document patient histories. Results For the first objective, among patients with hearing loss, eustachian tube dysfunction, nasal obstruction, and chronic rhinosinusitis, the areas under the ROC curves were 0.38 to 0.83. Spearman ρ coefficients were 0.25 to 0.46. Sensitivity and specificity ranged from 15.9% to 87.8%, with correct classification in 42.3% to 55.2% of cases. For the second objective, there was a 91% completion rate. Completion times were 7:18 to 12:37 for new patients and 3:23 to 6:41 for established patients. Physician time savings were estimated at 11 minutes per patient. Conclusions Using validated instruments and electronic data collection systems in daily practice has practical and clinical implications. These topics warrant further study. Level of Evidence 2c Laryngoscope, 130:S1–S13, 2020

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“…One of the nurse duties is to show documentation and manage patients health information through nursing care documentation (3). In the past two decades, most health workers especially nurses spend more time on writing documentation or medical records than that for applying therapeutic communication for patients and their families (4) . Documentation of nursing care is considered as significant indicators, which can influence the provision of nursing care, in either written form or electronic form.…”

Section: Introductionmentioning

confidence: 99%

The Implementation of Electronic based Nursing Care Documentation to EFETEC; A Literature Review

Saraswasta¹,

Hariyati²

2019

IJNHS

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ABSTRACT In last two decades most of the tasks performed by nurses have not been directly related to patient care. Nurses spend more time on writing documentation or medical records of patients. Implementation of electronic medical record can reduce the time used for documentation or in other hand will increase the time for nurses to interact with patients then eventually can improve the quality of nursing care. Purpose of this literature review is to find out the implementation of electronic-based nursing care documentation (EHR) in improving the quality of nursing care in terms of EFETEC aspects. Method used by author is a literature review. Database used is Science Direct, PROQUEST, Scopus, Ebscho and Scholar Article with the keywords; electronic health record, EHR, Documentation in nursing, Quality of nursing care. Implementation of electronic nursing care documentation can improve the service quality. Improvement of the quality of service is reviewed with EFETEC which consists of efficient, focus for patient, effective, time discipline, equality, confidentiality. In the era of health workers 4.0 the utilization of electronic nursing care documentation requires continuous development in order to improve the quality of service for patients. KEYWORDS: electronic health record, nursing care documentation, quality of nursing care

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The impact of electronic health record systems on clinical documentation times: A systematic review

Cited by 222 publications

References 36 publications

Promoting Quality Face-to-Face Communication during Ophthalmology Encounters in the Electronic Health Record Era

Promoting Quality Face-to-Face Communication during Ophthalmology Encounters in the Electronic Health Record Era

The Utility and Feasibility of Extending Beyond Traditional Patient Descriptions in Daily Practice

The Implementation of Electronic based Nursing Care Documentation to EFETEC; A Literature Review

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