Interaction Time with Electronic Health Records: A Systematic Review

BACKGROUND

The amount of time that health care clinicians (physicians and nurses) spend interacting with the electronic health record is not well understood.

OBJECTIVE

This study aimed to evaluate the time that health care providers spend interacting with electronic health records (EHR).

METHODS

Data are retrieved from Ovid MEDLINE(R) and Epub Ahead of Print, In-Process and Other Non-Indexed Citations and Daily, (Ovid) Embase, CINAHL, and SCOPUS.

STUDY ELIGIBILITY CRITERIA

Peer-reviewed studies that describe the use of EHR and include measurement of time either in hours, minutes, or in the percentage of a clinician's workday. Papers were written in English and published between 1990 and 2021.

PARTICIPANTS

All physicians and nurses involved in inpatient and outpatient settings.

STUDY APPRAISAL AND SYNTHESIS METHODS

A narrative synthesis of the results, providing summaries of interaction time with EHR. The studies were rated according to Quality Assessment Tool for Studies with Diverse Designs.

RESULTS

Out of 5,133 de-duplicated references identified through database searching, 18 met inclusion criteria. Most were time-motion studies (50%) that followed by logged-based analysis (44%). Most were conducted in the United States (94%) and examined a clinician workflow in the inpatient settings (83%). The average time was nearly 37% of time of their workday by physicians in both inpatient and outpatient settings and 22% of the workday by nurses in inpatient settings. The studies showed methodological heterogeneity.

CONCLUSION

This systematic review evaluates the time that health care providers spend interacting with EHR. Interaction time with EHR varies depending on clinicians' roles and clinical settings, computer systems, and users' experience. The average time spent by physicians on EHR exceeded one-third of their workday. The finding is a possible indicator that the EHR has room for usability, functionality improvement, and workflow optimization.

Impact of Provider Prior Use of HIE on System Complexity, Performance, Patient Care, Quality and System Concerns

To date, most HIE studies have investigated user perceptions of value prior to use. Few studies have assessed factors associated with the value of HIE through its actual use. This study investigates provider perceptions on HIE comparing those who had prior experience vs those who had no experience with it. In so doing, we identify six constructs: prior use, system complexity, system concerns, public/population health, care delivery, and provider performance. This study uses a mixed methods approach to data collection. From 15 interviews of medical community leaders, a survey was constructed and administered to 263 clinicians. Descriptive statistics and analysis of variance was used, along with Tukey HSD tests for multiple comparisons. Results indicated providers whom previously used HIE had more positive perceptions about its benefits in terms of system complexity (p = .001), care delivery (p = .000), population health (p = .003), and provider performance (p = .005); women providers were more positive in terms of system concerns (p = .000); patient care (p = .031), and population health (p = .009); providers age 44-55 were more positive than older and younger groups in terms of patient care (p = .032), population health (p = .021), and provider performance (p = .014); while differences also existed across professional license groups (physician, nurse, other license, admin (no license)) for all five constructs (p < .05); and type of organization setting (hospital, ambulatory clinic, medical office, other) for three constructs including system concerns (p = .017), population health (p = .018), and provider performance (p = .018). There were no statistically significant differences found between groups based on a provider's role in an organization (patient care, administration, teaching/research, other). Different provider perspectives about the value derived from HIE use exist depending on prior experience with HIE, age, gender, license (physician, nurse, other license, admin (no license)), and type of organization setting (hospital, ambulatory clinic, medical office, other). This study draws from the theory of planned behavior to understand factors related to physicians' perceptions about HIE value, serving as a departure point for more detailed investigations of provider perceptions and behavior in regard to future HIE use and promoting interoperability.

The Development and Evaluation of an Electronic Health Record Efficiency Workshop for Providers

BACKGROUND

The electronic health record (EHR) has historically been known to be a source of stress and dissatisfaction, leading to reduced efficiency and productivity for providers. This issue is complicated by constant changes in EHRs that are necessary to keep systems current with evolving functionality. Knowing the existence of this problem, an evidenced-based solution, known as an efficiency workshop, was developed by our information technology training and optimization team for providers as a means of ongoing professional development.

OBJECTIVES

The objectives of this project were to identify EHR optimization needs for providers in various clinical departments and improve their EHR satisfaction. The development of a program focused on provider efficiency tools and personalization was key and, once piloted, how to measure program success.

METHODS

Efficiency workshops comprised members of the IT training team who set up on site training sessions during reserved time with providers during departmental meetings. Sessions focused on reviewing EHR efficiency tools using demonstration of existing system functionality. Participating providers were given continuing medical education (CME) credits upon completion of evaluations used as a quality improvement tool for the program.

RESULTS

Descriptive results showed that providers were satisfied with this method of EHR instruction. Subjective feedback yielded positive themes such as informative, well done, organized, and helpful.

CONCLUSION

This initiative began as a pilot program and successfully expanded across clinical departments at our academic medical center. Future plans are to sustain and further invest in this program by using EHR reporting features to further customize these sessions and evaluate impact on system use.

THE IMPACT OF VIDEO VISITS ON MEASURES OF CLINICAL EFFICIENCY AND REIMBURSEMENT

Introduction

Telehealth is gaining more attention in multiple specialties, including urology. Video visits in particular have shown high satisfaction and cost-saving for patients. However, there has been little investigation into how video visits compare to traditional clinic visits on measures of clinical efficiency and reimbursement.

Methods

Our dataset included 250 video visits of established patients at Michigan Medicine Department of Urology and 250 in-person clinic visits with the same providers completed between July 2016 and July 2017. Information on visit completion and cancellation rates; cycle time (time from check in to check out); reimbursement; and patient out-of-pocket expenses was collected using the electronic medical record and billing data.

Results

Completion rates were similar between video and clinic visits (58% versus 61%, respectively; p=0.24). Average cycle time for video visits was significantly shorter compared to clinic visits (24 min vs 80 min, respectively; p<0.01). Neither average commercial payer reimbursement (p=0.21) nor average out-of-pocket expense (p=0.22) was statistically different between video and traditional visits. More video visits than clinic visits were billed as level 3 encounters (85% and 63%, respectively, p=0.002).

Conclusions

Our study demonstrates that video visits have the potential to reduce the time patients spend on follow-up care without negatively impacting reimbursement rates. However, these visits could reduce average billing levels. These findings suggest that the incorporation of video visits into practice may be more efficient for patients but may also reduce billing levels.

Perceptions of Electronic Health Records Within Otolaryngology Residents Compared to Practicing Otolaryngologists

OBJECTIVE

This study investigated the perceived impact of electronic health records (EHR) on otolaryngology residents with regard to education, patient care, and workflow, and then compared the trends with those of practicing otolaryngologists.

METHODS

A descriptive, cross-sectional survey was developed for each core study group: the otolaryngology resident group (ORG) and the practicing otolaryngologist group (POG). In total, 536 surveys were submitted: 33 from the ORG survey and 510 from the POG survey. Response rates were 51.5% and 21.3%, respectively.

RESULTS

Within the two study groups, ORG reported a predominately neutral response relating to the impact of EHR on experience compared with the POG, which reported far more negative responses. The most negative reported change in the ORG related to feeling more like a passive observer and scribe in terms of how EHR negatively impacted the role of resident. Within the POG group, the majority of negative responses were recorded on the impact of EHR on practice efficiency, practice overhead, and number of employees required to maintain practice function.

CONCLUSION

With otolaryngologists making up 1.1% of the U.S. physician workforce in 2015, it is likely that software programing of EHR underrepresents the workflow needs of otolaryngologists at this time. Future studies investigating the impact of EHR on otolaryngology patient care and resident education are needed in the future. Laryngoscope, 128:2726-2731, 2018.

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

Background

Numerous studies have examined factors related to success, failure and implications of electronic patient record (EPR) system implementations, but usually limited to specific aspects.

Objective

To 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.

Method

Literature review.

Results

Three 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.

Conclusion

The 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.

Patient Expectations and Preferences in the Spinal Surgery Clinic

BACKGROUND

Managing patient expectations is essential in the treatment of patients undergoing spinal surgery. Patient satisfaction is associated with improved clinical outcomes and can be improved when patient and surgeon expectations are aligned and patient preferences are met.

METHODS

Patients presenting to clinic for management of spinal disease were asked to complete a questionnaire assessing demographics, current pain, reason for visit, and expectations and preferences surrounding the clinic experience. Variables were compared with χ² tests to determine factors associated with patient expectations. Subsets of new patients and returning patients were compared by the use of matched pair tests. One-way analysis of variance was used to compare means of clinic expectations in patients depending on their level of education.

RESULTS

A total of 240 patients were included. New patient evaluation was the most common reason for evaluation (26.6%), and pain relief was the most common chief concern (39.3%). Patients preferred their surgeon wash their hands in the room instead of before entering (P < 0.001) and wear professional attire over scrubs (P < 0.001). Patients believe their wait time will be longer than it should be (P = 0.002), they will spend longer in clinic than they should (P = 0.03), and they will get less face-to-face time with their surgeon than they should (P < 0.01) but also that the surgeon is not getting paid enough for the clinic visit (P = 0.02).

CONCLUSIONS

Because spine surgery is largely elective, patients often seek treatment to improve quality of life and alleviate subjective symptoms. Understanding patient expectations is critical to ensure that patients and physicians are working toward similar goals.