TY - JOUR
T1 - Changes in Electronic Health Record Use Time and Documentation over the Course of a Decade
AU - Goldstein, Isaac H.
AU - Hwang, Thomas
AU - Gowrisankaran, Sowjanya
AU - Bales, Ryan
AU - Chiang, Michael F.
AU - Hribar, Michelle R.
N1 - Funding Information:
Supported by Research to Prevent Blindness, Inc, New York, New York (unrestricted departmental funding); and the National Institutes of Health, Bethesda, Maryland (grants R00LM12238, [M.R.H.], P30EY10572, and R01EY19474 [M.F.C.]). The funding organizations had no role in the design or conduct of this research. Financial Disclosure(s): The author(s) have made the following disclosure(s): M.F.C.: Consultant – Novartis (Basel, Switzerland); Scientific Advisory Board – Clarity Medical Systems (Pleasanton, CA); Initial member – Inteleretina, LLC (Honolulu, HI). Supported by Research to Prevent Blindness, Inc, New York, New York (unrestricted departmental funding); and the National Institutes of Health, Bethesda, Maryland (grants R00LM12238, [M.R.H.], P30EY10572, and R01EY19474 [M.F.C.]). The funding organizations had no role in the design or conduct of this research. HUMAN SUBJECTS: Human subjects were included in this study. The human ethics committees at Oregon Health & Science University approved the study. This research adhered to the tenets of the Declaration of Helsinki, and was approved by the OHSU institutional review board, which granted a waiver of informed consent for analysis of coded electronic health record data in this study. Obtained funding: Hribar, Chiang
Publisher Copyright:
© 2019 American Academy of Ophthalmology
PY - 2019/6
Y1 - 2019/6
N2 - Purpose: With the current wide adoption of electronic health records (EHRs) by ophthalmologists, there are widespread concerns about the amount of time spent using the EHR. The goal of this study was to examine how the amount of time spent using EHRs as well as related documentation behaviors changed 1 decade after EHR adoption. Design: Single-center cohort study. Participants: Six hundred eighty-five thousand three hundred sixty-one office visits with 70 ophthalmology providers. Methods: We calculated time spent using the EHR associated with each individual office visit using EHR audit logs and determined chart closure times and progress note length from secondary EHR data. We tracked and modeled how these metrics changed from 2006 to 2016 with linear mixed models. Main Outcome Measures: Minutes spent using the EHR associated with an office visit, chart closure time in hours from the office visit check-in time, and progress note length in characters. Results: Median EHR time per office visit in 2006 was 4.2 minutes (interquartile range [IQR], 3.5 minutes), and increased to 6.4 minutes (IQR, 4.5 minutes) in 2016. Median chart closure time was 2.8 hours (IQR, 21.3 hours) in 2006 and decreased to 2.3 hours (IQR, 18.5 hours) in 2016. In 2006, median note length was 1530 characters (IQR, 1435 characters) and increased to 3838 characters (IQR, 2668.3 characters) in 2016. Linear mixed models found EHR time per office visit was 31.9±0.2% (P < 0.001) greater from 2014 through 2016 than from 2006 through 2010, chart closure time was 6.7±0.3 hours (P < 0.001) shorter from 2014 through 2016 versus 2006 through 2010, and note length was 1807.4±6.5 characters (P < 0.001) longer from 2014 through 2016 versus 2006 through 2010. Conclusions: After 1 decade of use, providers spend more time using the EHR for an office visit, generate longer notes, and close the chart faster. These changes are likely to represent increased time and documentation pressure for providers. Electronic health record redesign and new documentation regulations may help to address these issues.
AB - Purpose: With the current wide adoption of electronic health records (EHRs) by ophthalmologists, there are widespread concerns about the amount of time spent using the EHR. The goal of this study was to examine how the amount of time spent using EHRs as well as related documentation behaviors changed 1 decade after EHR adoption. Design: Single-center cohort study. Participants: Six hundred eighty-five thousand three hundred sixty-one office visits with 70 ophthalmology providers. Methods: We calculated time spent using the EHR associated with each individual office visit using EHR audit logs and determined chart closure times and progress note length from secondary EHR data. We tracked and modeled how these metrics changed from 2006 to 2016 with linear mixed models. Main Outcome Measures: Minutes spent using the EHR associated with an office visit, chart closure time in hours from the office visit check-in time, and progress note length in characters. Results: Median EHR time per office visit in 2006 was 4.2 minutes (interquartile range [IQR], 3.5 minutes), and increased to 6.4 minutes (IQR, 4.5 minutes) in 2016. Median chart closure time was 2.8 hours (IQR, 21.3 hours) in 2006 and decreased to 2.3 hours (IQR, 18.5 hours) in 2016. In 2006, median note length was 1530 characters (IQR, 1435 characters) and increased to 3838 characters (IQR, 2668.3 characters) in 2016. Linear mixed models found EHR time per office visit was 31.9±0.2% (P < 0.001) greater from 2014 through 2016 than from 2006 through 2010, chart closure time was 6.7±0.3 hours (P < 0.001) shorter from 2014 through 2016 versus 2006 through 2010, and note length was 1807.4±6.5 characters (P < 0.001) longer from 2014 through 2016 versus 2006 through 2010. Conclusions: After 1 decade of use, providers spend more time using the EHR for an office visit, generate longer notes, and close the chart faster. These changes are likely to represent increased time and documentation pressure for providers. Electronic health record redesign and new documentation regulations may help to address these issues.
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U2 - 10.1016/j.ophtha.2019.01.011
DO - 10.1016/j.ophtha.2019.01.011
M3 - Article
C2 - 30664893
AN - SCOPUS:85061645236
SN - 0161-6420
VL - 126
SP - 783
EP - 791
JO - Ophthalmology
JF - Ophthalmology
IS - 6
ER -