July 2019
Volume 60, Issue 9
Free
ARVO Annual Meeting Abstract  |   July 2019
Time-motion analysis of paper-based clinical workflows in a multi-specialty academic ophthalmology practice
Author Affiliations & Notes
  • Sally Liu Baxter
    Shiley Eye Institute and Viterbi Family Department of Ophthalmology, University of California San Diego, La Jolla, California, United States
    UCSD Health Department of Biomedical Informatics, University of California San Diego, La Jolla, California, United States
  • Helena Elizabeth Gali
    Shiley Eye Institute and Viterbi Family Department of Ophthalmology, University of California San Diego, La Jolla, California, United States
    UCSD Health Department of Biomedical Informatics, University of California San Diego, La Jolla, California, United States
  • Abigail E Huang
    Department of Ophthalmology, Casey Eye Institute, Oregon Health & Science University, Portland, Oregon, United States
    Department of Medical Informatics & Clinical Epidemiology, Oregon Health & Science University, Portland, Oregon, United States
  • Marlene Millen
    UCSD Health Department of Biomedical Informatics, University of California San Diego, La Jolla, California, United States
  • Robert El-Kareh
    UCSD Health Department of Biomedical Informatics, University of California San Diego, La Jolla, California, United States
  • Eric Nudleman
    Shiley Eye Institute and Viterbi Family Department of Ophthalmology, University of California San Diego, La Jolla, California, United States
  • Shira L Robbins
    Shiley Eye Institute and Viterbi Family Department of Ophthalmology, University of California San Diego, La Jolla, California, United States
  • Christopher W.D. Heichel
    Shiley Eye Institute and Viterbi Family Department of Ophthalmology, University of California San Diego, La Jolla, California, United States
  • Andrew S. Camp
    Shiley Eye Institute and Viterbi Family Department of Ophthalmology, University of California San Diego, La Jolla, California, United States
  • Bobby S Korn
    Shiley Eye Institute and Viterbi Family Department of Ophthalmology, University of California San Diego, La Jolla, California, United States
  • Jeffrey Ewing Lee
    Shiley Eye Institute and Viterbi Family Department of Ophthalmology, University of California San Diego, La Jolla, California, United States
  • Don Osami Kikkawa
    Shiley Eye Institute and Viterbi Family Department of Ophthalmology, University of California San Diego, La Jolla, California, United States
  • Christopher A. Longhurst
    UCSD Health Department of Biomedical Informatics, University of California San Diego, La Jolla, California, United States
  • Michael F Chiang
    Department of Ophthalmology, Casey Eye Institute, Oregon Health & Science University, Portland, Oregon, United States
    Department of Medical Informatics & Clinical Epidemiology, Oregon Health & Science University, Portland, Oregon, United States
  • Michelle Hribar
    Department of Ophthalmology, Casey Eye Institute, Oregon Health & Science University, Portland, Oregon, United States
    Department of Medical Informatics & Clinical Epidemiology, Oregon Health & Science University, Portland, Oregon, United States
  • Lucila Ohno-Machado
    UCSD Health Department of Biomedical Informatics, University of California San Diego, La Jolla, California, United States
    Division of Health Services Research and Development, Veterans Administration San Diego Healthcare System, La Jolla, California, United States
  • Footnotes
    Commercial Relationships   Sally Baxter, None; Helena Gali, None; Abigail Huang, None; Marlene Millen, None; Robert El-Kareh, None; Eric Nudleman, None; Shira Robbins, None; Christopher Heichel, None; Andrew Camp, None; Bobby Korn, None; Jeffrey Lee, None; Don Kikkawa, None; Christopher Longhurst, None; Michael Chiang, None; Michelle Hribar, None; Lucila Ohno-Machado, None
  • Footnotes
    Support  T15LM011271, R00LM12238, P30EY10572, UL RR031980, P30EY022589, Heed Ophthalmic Foundation
Investigative Ophthalmology & Visual Science July 2019, Vol.60, 5505. doi:https://doi.org/
  • Views
  • Share
  • Tools
    • Alerts
      ×
      This feature is available to authenticated users only.
      Sign In or Create an Account ×
    • Get Citation

      Sally Liu Baxter, Helena Elizabeth Gali, Abigail E Huang, Marlene Millen, Robert El-Kareh, Eric Nudleman, Shira L Robbins, Christopher W.D. Heichel, Andrew S. Camp, Bobby S Korn, Jeffrey Ewing Lee, Don Osami Kikkawa, Christopher A. Longhurst, Michael F Chiang, Michelle Hribar, Lucila Ohno-Machado; Time-motion analysis of paper-based clinical workflows in a multi-specialty academic ophthalmology practice. Invest. Ophthalmol. Vis. Sci. 2019;60(9):5505. doi: https://doi.org/.

      Download citation file:


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

      ×
  • Supplements
Abstract

Purpose : Efforts to improve electronic health record (EHR) use in ophthalmology can be enhanced by deeper understanding of clinical workflows and documentation that rely on traditional paper-based methods. While time requirements associated with EHR use in ophthalmology have been characterized, data for paper-based documentation are lacking. The objectives of this study were to assess time requirements for patient encounters, after-hours utilization, and relative efficiencies and inefficiencies of paper-based clinical workflows in outpatient ophthalmology.

Methods : Prospective mixed-methods study entailing time-motion observations and survey of attending ophthalmologists using paper-based documentation in an academic ophthalmology department in September 2018. Manual time-motion observations were conducted for seven attending ophthalmologists from six subspecialties (414 patient encounters). Total time spent by attending ophthalmologists per patient was recorded, as well as time spent on documentation, examination, procedures, and time talking with patients, staff, and trainees. The survey covered clinical workflows and after-hours documentation.

Results : Among the 7 attending ophthalmologists in this study (6 men and 1 woman, mean [SD] age, 43.9 [7.1] years), the mean (SD) total time spent per patient was 8.1 (4.8) minutes, with 2.8 (1.4) minutes (38%) for documentation, 1.2 (0.9) minutes (17%) for examination, 3.3 (3.1) minutes (37%) for talking with patients, and the remainder on other activities (i.e. performing procedures or talking with staff). Linear mixed effects models revealed that new patient evaluations required significantly more time than routine follow-up visits and post-operative visits. Higher clinical volumes were associated with reduced time per patient. Based on survey results from 12 attending ophthalmologists, 9 (75%) of respondents endorsed doing no documentation-related work on weeknights. On weekends, 8 (66%) did no work, 3 (25%) worked <1 hour, 1 (8%) worked 1-2 hours, and none worked >2 hours.

Conclusions : Paper-based documentation comprises a substantial portion of the total time spent for patient care in outpatient ophthalmology clinics but is associated with minimal after-hours work. Understanding paper-based clinical workflows may help inform targeted strategies for improving EHR use in ophthalmology.

This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.

×
×

This PDF is available to Subscribers Only

Sign in or purchase a subscription to access this content. ×

You must be signed into an individual account to use this feature.

×