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.