June 2017
Volume 58, Issue 8
Open Access
ARVO Annual Meeting Abstract  |   June 2017
The impact of clinic volume and level of service on time requirements for electronic health records (EHRs) within ophthalmology
Author Affiliations & Notes
  • Sarah Read-Brown
    Ophthalmology, Oregon Health & Science University, Portland, Oregon, United States
  • Michelle Hribar
    Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland, Oregon, United States
  • Thomas R Yackel
    Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland, Oregon, United States
  • Michael F Chiang
    Ophthalmology, Oregon Health & Science University, Portland, Oregon, United States
    Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland, Oregon, United States
  • Footnotes
    Commercial Relationships   Sarah Read-Brown, None; Michelle Hribar, None; Thomas Yackel, None; Michael Chiang, Clarity Medical Systems (Pleasanton, CA) (S), Novartis (Basel, Switzerland) (C)
  • Footnotes
    Support  supported by grant K99LM012238, NLM grant P30EY10572 from the National Institutes of Health (Bethesda, MD), and by unrestricted departmental funding from Research to Prevent Blindness (New York, NY).
Investigative Ophthalmology & Visual Science June 2017, Vol.58, 5087. doi:
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    • Get Citation

      Sarah Read-Brown, Michelle Hribar, Thomas R Yackel, Michael F Chiang; The impact of clinic volume and level of service on time requirements for electronic health records (EHRs) within ophthalmology. Invest. Ophthalmol. Vis. Sci. 2017;58(8):5087.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract

Purpose : Physicians have raised concerns that electronic health records (EHRs) have negatively impacted their clinical productivity, and report spending excessive time for computer use. Little published work has been done to provide quantitative data about this issue. This study analyzes factors related to time requirements for EHR use for 31 ophthalmologists using an institution-wide EHR (EpicCare; Epic Systems, Verona, WI).

Methods : We queried the EHR audit logs and data mart for 31 ophthalmologists with stable practices for a 1-year period in 2014. Physician time requirements for EHR use were calculated from these data using methods that we have previously published. With the help of a billing specialist, we categorized appointment billing codes into three complexity levels: low, medium, and high. We used R (R Core Team, 2016) and lme4 (Bates, Maechler, Bolker, & Walker, 2015) to perform a linear mixed effects analysis of the relationship between the total EHR use for the encounter and its billing level and clinic session volume as fixed effects, with the providers and patients as random effects.

Results : Mean EHR usage time was 10.2 ± 7.5 minutes/patient. Providers’ mean total EHR use time varied from 5.8-22.4 minutes/patient. On average, providers spent 1.8 hours using the EHR per half-day clinic session, about 1 hour of which occurred during the patient exam and 0.8 hours of which occurred after the exam. Clinic session volume affected the EHR use time, shortening it by about 1% for each patient added to the clinic session (p<0.001). The billing level increased the EHR use time by 29% for medium billing level vs. low billing level, and by 54% for high level vs. low level (p< 0.001).

Conclusions : EHRs require significant time use by providers, both during patient exams and afterward. Increases in appointment billing levels significantly lengthen EHR time use, while increases in clinic volume shorten provider EHR time use per patient. Studies on improving EHR interfaces and reducing the time burden of EHRs are warranted.

This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.

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