@article{50f0c5fb42604791859bcacc0273da14,
title = "Time Requirements of Paper-Based Clinical Workflows and After-Hours Documentation in a Multispecialty Academic Ophthalmology Practice",
abstract = "Purpose: To assess time requirements for patient encounters and estimate after-hours demands of paper-based clinical workflows in ophthalmology. Design: Time-and-motion study with a structured survey. Methods: This study was conducted in a single academic ophthalmology department. A convenience sample consisted of 7 attending ophthalmologists from 6 subspecialties observed during 414 patient encounters for the time-motion analysis and 12 attending ophthalmologists for the survey. Outcome measurements consisted of total time spent by attending ophthalmologists per patient and time spent on documentation, examination, and talking with patients. The survey assessed time requirements of documentation-related activities performed outside of scheduled clinic hours. Results: Among the 7 attending ophthalmologists observed (6 men and 1 woman), mean ± SD age 43.9 ± 7.1 years, during encounters with 414 patients (57.8 ± 24.6 years of age), total time spent per patient was 8.1 ± 4.8 minutes, with 2.8 ± 1.4 minutes (38%) for documentation, 1.2 ± 0.9 minutes (17%) for examination, and 3.3 ± 3.1 minutes (37%) for talking with patients. New patient evaluations required significantly more time than routine follow-up visits and postoperative visits. Higher clinical volumes were associated with less time per patient. Survey results indicated that paper-based documentation was associated with minimal after-hours work on weeknights and weekends. Conclusions: Paper-based documentation takes up a substantial portion of the total time spent for patient care in outpatient ophthalmology clinics but is associated with minimal after-hours work. Understanding paper-based clinical workflows may help inform targeted strategies for improving electronic health record use in ophthalmology.",
author = "Baxter, {Sally L.} and Gali, {Helena E.} and Huang, {Abigail E.} and Marlene Millen and Robert El-Kareh and Eric Nudleman and Robbins, {Shira L.} and Heichel, {Christopher W.D.} and Camp, {Andrew S.} and Korn, {Bobby S.} and Lee, {Jeffrey E.} and Kikkawa, {Don O.} and Longhurst, {Christopher A.} and Chiang, {Michael F.} and Hribar, {Michelle R.} and Lucila Ohno-Machado",
note = "Funding Information: All authors have completed and submitted the ICMJE form for Disclosure of Potential Conflicts of Interest and none were reported. Financial Disclosures: M.F.C. is a consultant for Novartis (Basel, Switzerland). S.L.R. is a consultant for the US Department of Health and Human Services, Prometric, and Nevakar; and receives royalties from Elsevier, Spring, and the American Academy of Pediatrics; and receives grant support from Retrophin. A.E.H. is a medical specialist at Advanced Clinical (Deerfield, IL). The other authors have indicated no financial support or financial conflict of interest. Funding/Support: This study was supported by US National Institutes of Health (Bethesda, Maryland) grants T15LM011271, R00LM12238, P30EY10572, P30EY022589, and UL RR031980, by the Heed Ophthalmic Foundation Fellowship (San Francisco, California), and by unrestricted grants from Research to Prevent Blindness (New York, New York). The funding organizations had no input on the study design or analysis. The authors thank the UCSD student observers who assisted with time-motion data collection, Jennie Xu, Citra Khalil, Ala'a Erras, Dennis Tran, Nguyen, and Neil E. Shah. Funding Information: All authors have completed and submitted the ICMJE form for Disclosure of Potential Conflicts of Interest and none were reported. Financial Disclosures: M.F.C. is a consultant for Novartis (Basel, Switzerland). S.L.R. is a consultant for the US Department of Health and Human Services, Prometric, and Nevakar; and receives royalties from Elsevier, Spring, and the American Academy of Pediatrics; and receives grant support from Retrophin . A.E.H. is a medical specialist at Advanced Clinical (Deerfield, IL). The other authors have indicated no financial support or financial conflict of interest. Funding/Support: This study was supported by US National Institutes of Health (Bethesda, Maryland) grants T15LM011271 , R00LM12238 , P30EY10572 , P30EY022589 , and UL RR031980 , by the Heed Ophthalmic Foundation Fellowship (San Francisco, California), and by unrestricted grants from Research to Prevent Blindness (New York, New York). The funding organizations had no input on the study design or analysis. Publisher Copyright: {\textcopyright} 2019",
year = "2019",
month = oct,
doi = "10.1016/j.ajo.2019.03.014",
language = "English (US)",
volume = "206",
pages = "161--167",
journal = "American journal of ophthalmology",
issn = "0002-9394",
publisher = "Elsevier USA",
}