The Practice Impact of Electronic Health Record System Implementation Within a Large Multispecialty Ophthalmic Practice

Singh, Rishi P.; Bedi, Rumneek; Li, Ang; Kulkarni, Sharmila; Rodstrom, Tiffany; Altus, Gene; Martín, Daniel

doi:10.1001/jamaophthalmol.2015.0457

Cited by 18 publications

(16 citation statements)

References 10 publications

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“…In a pre-/post-implementation study in a specialist eye hospital, there was no significant change in patient volume or diagnostic tests usage,87 whereas a similar study in an emergency department reported increased patient processing time, which improved to better than baseline over 10 months. In an outpatient study, physician productivity initially decreased by 20%, but with the corresponding reduced time spent post-clinic reviewing documentation 88.…”

Section: Resultsmentioning

confidence: 87%

What to expect from electronic patient record system implementation: lessons learned from published evidence

Priestman

Sridharan

Vigne

et al. 2018

BMJ Health Care Inform

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BackgroundNumerous studies have examined factors related to success, failure and implications of electronic patient record (EPR) system implementations, but usually limited to specific aspects.ObjectiveTo review the published peer-reviewed literature and present findings regarding factors important in relation to successful EPR implementations and likely impact on subsequent clinical activity.MethodLiterature review.ResultsThree hundred and twelve potential articles were identified on initial search, of which 117 were relevant and included in the review. Several factors were related to implementation success, such as good leadership and management, infrastructure support, staff training and focus on workflows and usability. In general, EPR implementation is associated with improvements in documentation and screening performance and reduced prescribing errors, whereas there are minimal available data in other areas such as effects on clinical patient outcomes. The peer-reviewed literature appears to under-represent a range of technical factors important for EPR implementations, such as data migration from existing systems and impact of organisational readiness.ConclusionThe findings presented here represent the synthesis of data from peer-reviewed literature in the field and should be of value to provide the evidence-base for organisations considering how best to implement an EPR system.

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Section: Resultsmentioning

confidence: 87%

What to expect from electronic patient record system implementation: lessons learned from published evidence

Priestman

Sridharan

Vigne

et al. 2018

BMJ Health Care Inform

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“…Other studies in academic ophthalmology clinics have found mixed effects from EHR adoption [ 23 – 27 ]. A large study of an entire department reported increased provider non-clinic documentation time with EHR, 6.8 min more per encounter versus paper charting, but with only a 3 % decrease in clinic volume at 2 and 3 years after implementation.…”

Section: Discussionmentioning

confidence: 99%

“…Another study of an academic department consisting of 23 physicians reported no significant change in total patient volume, although glaucoma specialists significantly increased their volume [ 27 ]. However, the authors noted that the department had access to substantial financial and human resources, including a large capital budget for optimization and support staff that was temporarily redistributed during the implementation process.…”

Section: Discussionmentioning

confidence: 99%

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

Lam

Lee

Chen

2015

BMC Health Serv Res

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BackgroundElectronic health records (EHRs) have become a mandated part of delivering health care in the United States. The purpose of this study is to report patient volume before and after the transition to EHR in an academic outpatient ophthalmology practice.MethodsReview of patient visits per half-day and number of support staff for established faculty ophthalmologists between July and October for five consecutive years beginning the year before EHR implementation.ResultsEight physicians met inclusion criteria for the study. The number of patient visits was lower in each year after EHR adoption compared to baseline p ≤ 0.027). Patient volume per provider was reduced an average of 16.9 % over the 4 years (range 15.3–18.5 %), and during the final year studied, no provider had returned to the pre-EHR number of patients per clinic session. Support staffing was unchanged (p > 0.2).ConclusionsAdoption of EHR was associated with a significantly reduced number of patient visits per clinic session in an academic setting in which support staffing remained stable. Maintaining clinic volume and access in similar settings may require use of additional staffing.

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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 Practice Impact of Electronic Health Record System Implementation Within a Large Multispecialty Ophthalmic Practice

Cited by 18 publications

References 10 publications

What to expect from electronic patient record system implementation: lessons learned from published evidence

What to expect from electronic patient record system implementation: lessons learned from published evidence

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

Impact of Electronic Health Record Implementation on Ophthalmology Trainee Time Expenditures

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