Time and Clerical Burden Posed by the Current Electronic Health Record for Orthopaedic Surgeons

Abstract

Introduction:The electronic health record (EHR) has become an integral part of modern medical practice. The balance of benefit versus burden of a required EHR remains inconclusive, with many studies identifying increasing physician burnout and less face-to-face patient contact because of increasing documentation demands. Few studies have investigated EHR burden in orthopaedic surgery practice. This study aimed to characterize and compare EHR usage patterns and time allocation within EHR between orthopaedic surgeons, other surgeons, and medicine physicians at an academic medical center. Methods: EHR usage was digitally tracked within a large academic medical center. EHR usage data were compiled for all physicians seeing outpatients from April 2018 to June 2019. The tracking metrics included time spent answering messages, typing notes, reviewing laboratories and imaging, reading notes, and placing orders. Physicians were subdivided between orthopaedic surgeons, other surgeons, and nonsurgeon/medical specialties. Statistical comparisons using a two-sample t-test were done between orthopaedic surgeon EHR usage patterns and other surgeons, in addition to orthopaedic surgeons versus nonsurgeons. Results: One thousand sixty physicians including 28 full-time orthopaedic surgeons, 134 other surgeons, and 898 nonsurgical medicine physicians met inclusion criteria. Orthopaedic surgeons saw on average 31 patients per office day compared with other surgeons at 18 patients per office day (P , 0.01) and nonsurgeons at 12 patients per office day (P , 0.01). Orthopaedic surgeons received more EHR messages while also being more efficient at answering EHR messages compared with other surgeons and nonsurgeons (P , 0.01). EHR tasks, including answering messages, placing orders, chart review, writing notes, and reviewing imaging, consumed 58% of an orthopaedic surgeon's scheduled office day with the largest contribution from required note writing.

Using event logs to observe interactions with electronic health records: an updated scoping review shows increasing use of vendor-derived measures

“… 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...…”

“…Looking at specific measures of EHR use reported in each study reveals additional differences, particularly regarding durations of EHR use ( Figure 4 ). Reported time-based measures included total time in the EHR (49 articles), 3 , 4 , 19 , 24–33 , 35–49 , 51–59 , 61 , 66 , 69–73 , 77 , 79 , 95 , 98 time in notes (32 articles), 3 , 4 , 7 , 19 , 24–32 , 35–38 , 40–46 , 48 , 51 , 55–58 , 79 , 109 time in inbox (23 articles), 2–4 , 19 , 24 , 25 , 27–29 , 35–38 , 42 , 43 , 45 , 47 , 48 , 51 , 61 , 62 , 70 , 71 time in chart review (23 articles), 3 , 4 , 24–27 , 29 , 31 , 32 , 35 , 36 , 40 , 42 , …”

“…Twenty-two studies reported a measure based on a set time period, of which 7 unique periods were used (5:30 pm –8:30 am and 12:30 pm –1:30 pm , 5:30 pm –7 am , 6 pm –6 am , 6 pm –7 am , 7 pm –7 am , 7 pm –8 am , and 7:30 pm –7:30 am ). 4 , 6 , 19 , 25 , 27 , 29 , 32 , 34 , 36 , 39 , 40 , 42 , 48 , 49 , 51 , 53 , 55 , 66 , 69–71 An overlapping set of 22 articles, including 9 that also reported time period-based measures, reported at least 1 measure based on clinician schedules. 4 , 6 , 19 , 27 , 28 , 30 , 34 , 37 , 38 , 40 , 41 , 43 , 44 , 47–50 , 67 , 69 , 72 , 77 , 119 These included time outside scheduled hours on days with appointments, time on days without appointments, and time after the patient checked out.…”

Electronic Health Record Usage Patterns Across Surgical Subspecialties

“…Despite this, none have broadly analyzed all surgical fields and attempted to describe predictors of time spent on EHR. [11][12][13][14][15] Moreover, there is evidence highlighting that women and less experienced clinicians spend more time on the EHR, possibly correlating with more feelings of burnout. 16 However, these studies were limited to the ambulatory setting and lacked an analysis on clinician characteristics, such as age, gender, and experience.…”