Abstract
Purpose: :
To compare the effect of an electronic medical record (EMR) vs. paper charting system on patient contact time by observing resident–patient interactions in general ophthalmology clinic.
Methods: :
Patient encounters were observed and timed in two resident ophthalmology clinics which use different record–keeping systems. The Veterans Affairs (VA) hospital clinic uses a paperless record system that requires data entry and retrieval at a computer terminal. The VA EMR was compared to the Wishard Hospital clinic, which is an all–paper system. Eleven patient encounters at each site were observed. Two timers were used by the observer during the encounters. One timer measured total encounter time (TPET), and the second measured the portion of the encounter that the physician’s primary attention was directed to the medical record (reading, charting, locating studies, etc.) rather than to the patient. This "chart time" (CT) was then expressed as a percentage of the TPET for each clinic visit, and averages for encounters at each clinic calculated.
Results: :
Average TPET was 19.9 and 22.4 minutes, respectively for the VA and Wishard clinics, while average CT was 9.0 and 6.9 minutes. The average chart time as a percentage of total patient encounter for each clinic was calculated. The VA clinic CT as percentage of TPET (CT/TPET*100) was 44.8% compared to Wishard clinic average of 33.3%.
Conclusions: :
The EMR used at the VA ophthalmology clinic is more time–consuming than an all–paper chart. In a 40 hour work week, the VA EMR would add an additional half day (4.6 hours) of charting time as compared to an all paper system. There are several contributing factors. First, it is more laborious to record ophthalmic exam findings entirely in plain text format on a keyboard without the ability to write freehand or draw pictures, as is easily done on a paper clinic note template. Also, the VA software system requires more time to access prior studies through the computer system (visual field studies, for example) than locating the results in a paper chart. An EMR that increases efficiency in comparison to an all paper system is required to gain widespread acceptance in clinical practice; inefficiencies in data entry and retrieval were identified as barriers in the VA EMR.
Keywords: clinical (human) or epidemiologic studies: health care delivery/economics/manpower