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Daniel Tu, David Sanders, Sarah Read-Brown, Anna Brown, Dongseok Choi, Thomas Yackel, Michael Chiang; Electronic Health Record Systems in Ophthalmology: Impact on Operating Room Time Requirements for Cataract Surgery. Invest. Ophthalmol. Vis. Sci. 2013;54(15):4414.
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Electronic health record (EHR) systems are currently promoted through federal incentives to improve the quality, efficiency and cost of ophthalmic care. However, only a minority of ophthalmologists and surgical centers have adopted EHRs. One concern is that EHRs may disrupt operating room workflow and increase documentation time. We aim to compare cataract surgery operating room time requirements using paper versus EHR systems at an academic ambulatory surgery center.
An EHR system for operative care (OpTime by Epic Systems, Madison, WI) was implemented in January 2012 by the ophthalmic ambulatory surgery center at Oregon Health & Science University. For 1 month prior to and 10 months following EHR implementation, a trained observer recorded cataract surgery duration, intraoperative documentation time, operating room turnover time and number of nursing staff. Descriptive statistics and two-sample t-tests with unequal variance were performed (StataCorp LP, College Station, TX).
Mean cataract surgery duration was 16.7 minutes (SD =11.4). Mean paper-based intraoperative documentation time was 6.8 (SD =1.2) minutes per surgery. During the initial 2 weeks after EHR implementation, intraoperative documentation time increased to 17.1 (SD =4.3) minutes (p<.0001), then decreased to 7.9 (SD =2.3) minutes by 6 to 10 months after EHR implementation, although this remained greater than paper documentation time (p<.05). There was no statistically significant difference between mean operating room turnover time with paper records (14.4 minutes) and mean turnover time 2 weeks or 6 to 10 months after EHR implementation (12.9 and 12.8 minutes, respectively). Only 1 nurse was needed per cataract surgery to complete both clinical care and documentation while using paper records, compared to a mean of 1.8 nurses while using EHRs.
EHR implementation for cataract surgery operative care was associated with increased intraoperative documentation time, but no significant change in operating room turnover time. Initially after EHR implementation, mean intraoperative documentation time more than doubled and was greater than mean surgery duration. Although EHR documentation time decreased over subsequent months, this was in the setting of increased nursing staff requirements. These findings have implications for the efficiency and cost of ophthalmic surgical care delivery.
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