Impact of electronic health record implementation on clinical workflows for ophthalmology trainees

Abstract

Purpose : Electronic health records (EHRs) are widely adopted, but time demand of EHR use on ophthalmology trainees is not well understood. Understanding these demands is important as links between EHR use and physician burnout emerge. This study evaluates the impact of EHR use on ophthalmology trainee time spent in an outpatient clinic undergoing EHR implementation.

Methods : Prospective time-motion study of ophthalmology trainees 2 weeks before and 6 weeks after EHR implementation in an academic ophthalmology department. Manual time-motion observations were conducted for 11 ophthalmology trainees in 6 subspecialty clinics. Time spent documenting, examining, and talking with patients was recorded using standardized data entry tools. Changes in time requirements before and after EHR implementation were evaluated using t-tests.

Results : Seven ophthalmology residents and four ophthalmology fellows were observed, with mean (SD) post-graduate year (PGY) training of 3.7 (1.2). One hundred and twenty one patients were observed with mean age 61.7 (20.6) years (range 1-96 years). Using paper charts, mean total time spent on each patient was 11.6 (6.5) minutes, with 5.4 (3.5) minutes spent documenting (48%). After EHR implementation, mean total time spent on each patient was 11.8 (6.9) minutes, with 6.8 (4.7) minutes spent documenting (57%). See Table 1. Total time expenditure per patient was not significantly changed after EHR implementation (95% confidence interval [CI] for difference in means: -2.78, 2.45; p=0.90). Documentation time did not change significantly after EHR implementation in absolute terms (95% CI: -3.13, 0.29; p=0.10), but was significantly greater as a proportion of total time (48% before to 57% after; 95% CI: -15.83, -2.17; p=0.011).

Conclusions : Total time spent per patient and absolute time spent on documentation was not significantly different whether ophthalmology trainees used paper charts or the recently implemented EHR. Percentage of total time spent on documentation increased significantly with early EHR use. Further evaluation may shed more light on trainee time spent in clinic once steady-state of EHR use is acheived. Evaluating EHR impact on ophthalmology trainee time expenditure may improve understanding of how trainees learn to use the EHR and also shed light on strategies to address trainee burnout.

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