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Daniel C. Tu, Sarah Read-Brown, Steven Bailey, Daniel Karr, Dongseok Choi, Thomas Hwang, Thomas Yackel, Michael F. Chiang; Implementation Of Electronic Health Record Systems In Ophthalmology: Impact On Provider Time Utilization. Invest. Ophthalmol. Vis. Sci. 2012;53(14):1403.
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Electronic health records (EHRs) are being promoted by the federal government, but only a small fraction of ophthalmologists have implemented them. One concern is a potential increase in provider time expenditure and after-hours documentation compared to traditional paper systems. We aim to (1) characterize time required by ophthalmic providers to complete clinical encounters using an EHR, and (2) compare time expenditure by providers using EHR vs. paper systems in an academic setting.
An institution-wide EHR (Epic; Madison, WI) was implemented in February 2006 by Casey Eye Institute (CEI), the ophthalmology department at Oregon Health & Science University. All stable providers were identified who worked at CEI both 5 months before and after a 3-year study period beginning with EHR implementation. The EHR was queried to identify the time each encounter was initiated and completed. To compare time expenditure between paper systems and EHR documentation, two ophthalmologists were identified that utilize EHR at CEI and utilize paper systems at satellite clinics. Logs of these clinics during 2011 recorded the numbers of patients seen, the amount of time spent in clinic, and the time outside scheduled clinic hours required to complete clinical and financial documentation. Descriptive statistics were used to analyze data.
23 stable providers (21 ophthalmologists, 2 optometrists) were identified, and 118,095 clinical encounters were reviewed. The time required for these providers to complete 25%, 50%, and 75% of patient encounters (including all clinical and financial documentation) was 69 minutes (1 hour, 9 minutes), 258 minutes (4 hours, 18 minutes), and 2,562 minutes (1 day, 18 hours, 42 minutes) respectively. EHR documentation completion was performed outside normal clinic hours (Mon-Fri, 8am-5pm) for approximately 35% of encounters. Logs generated by two ophthalmologists describing time utilization for 344 patient encounters (183 encounters utilizing EHR and 161 via paper charts) were reviewed. Based on these log data, each EHR patient encounter required an average of 7 additional minutes compared to paper systems; the majority of this additional time was spent completing clinical and financial documentation outside normal clinic hours.
EHR usage by ophthalmic providers involves increased time expenditure and time spent completing documentation after-hours, compared to traditional paper systems. Although there are significant benefits of EHRs, it will be important to identify and resolve areas of inefficiency to minimize the time burden and improve future adoption.
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