Time Requirements of Paper-Based Clinical Workflows and After-Hours Documentation in a Multispecialty Academic Ophthalmology Practice

Sally L. Baxter, Helena E. Gali, Abigail E. Huang, Marlene Millen, Robert El-Kareh, Eric Nudleman, Shira L. Robbins, Christopher W.D. Heichel, Andrew S. Camp, Bobby S. Korn, Jeffrey E. Lee, Don O. Kikkawa, Christopher A. Longhurst, Michael F. Chiang, Michelle R. Hribar, Lucila Ohno-Machado

Research output: Contribution to journalArticlepeer-review

4 Scopus citations


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.

Original languageEnglish (US)
Pages (from-to)161-167
Number of pages7
JournalAmerican journal of ophthalmology
StatePublished - Oct 2019

ASJC Scopus subject areas

  • Ophthalmology


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