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Michelle Hribar, Sarah Read-Brown, Maha Pasha, Leah Reznick, Thomas Yackel, Michael F Chiang; Time Motion Study of Electronic Health Record (EHR) Documentation Time in Ophthalmology Exams. Invest. Ophthalmol. Vis. Sci. 2014;55(13):5589.
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Popular perception is EHR adoption in ophthalmology has resulted in increased time spent documenting during patient exams. Documentation time with EHR has been shown to be worse than with paper charts, with much of the documentation time occurring after the exam is completed [Chan et al, Am J Ophthalmol 2013], [Chiang et al, Trans Am Ophthalmol Soc 2013]. The purpose of this study is to measure the proportion of time spent using an EHR during a patient encounter using time-motion methods.
We performed a time-motion study of patient exams in the Casey Eye Institute at Oregon Health & Science University. Using paper forms and time stamping software (Emerald Timestamp; Emerald Sequoia, Los Gatos, CA), data was collected by 2 observers who shadowed the ophthalmologist. We recorded the duration of time the ophthalmologist spent documenting in the EHR, talking, and examining the patient. If the ophthalmologist was multitasking and talking while either examining or documenting, this was recorded exclusively as examination or documentation time. Times spent doing each of the three activities was tabulated during each patient exam. Patient encounters were categorized for analysis as either “routine” or “complex” in the opinion of the ophthalmologist. An exam was considered complex if the diagnosis was difficult or if the patient was challenging (e.g. a crying infant).
Our observations represent 25 patient exams, on 4 days of clinic, from a single pediatric ophthalmologist. We found that the mean proportion of time spend documenting was 18% compared to 30% examining and talking 45% spend talking. This corresponded to mean ±SD times of 2.1 ± 1.1 minutes for documenting, 3.9 ± 2.7 minutes for examining, and 5.4 ± 2.3 minutes for talking (Table 1). Between routine vs. complex encounters, there were no statistically-significant differences in documentation or talking times between complex vs. routine exams (p = 0.1276, 0.2808 respectively), but there were nearly statistically-significant differences in times required for examining (p=0.0513).
EHR documentation time occupies a significant proportion of ophthalmology patient encounters. Future EHR designs that streamline data entry will help reduce the amount of time spent documenting during ophthalmologic exam, and allow more time for examination and communication.
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