July 2019
Volume 60, Issue 9
Open Access
ARVO Annual Meeting Abstract  |   July 2019
Electronic health record documentation in ophthalmology: How many prior notes do clinicians review?
Author Affiliations & Notes
  • Michelle Hribar
    Department of Medical Informatics & Clinical Epidemiology, Oregon Health & Science University, Portland, Oregon, United States
    Department of Ophthalmology, Casey Eye Institute, Oregon Health & Science University, Portland, Oregon, United States
  • Isaac Goldstein
    Department of Ophthalmology, Casey Eye Institute, Oregon Health & Science University, Portland, Oregon, United States
  • Jimmy Chen
    School of Medicine, OHSU, Portland, Oregon, 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
  • Footnotes
    Commercial Relationships   Michelle Hribar, None; Isaac Goldstein, None; Jimmy Chen, None; Michael Chiang, Clarity Medical Systems (Pleasanton, CA) (S), Inteleretina (I), Novartis (C)
  • Footnotes
    Support  NIH Grant P30 EY010572, NLM Grant R00LM012238, and Unrestricted departmental funding from Research to Prevent Blindness
Investigative Ophthalmology & Visual Science July 2019, Vol.60, 5506. doi:
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      Michelle Hribar, Isaac Goldstein, Jimmy Chen, Michael F Chiang; Electronic health record documentation in ophthalmology: How many prior notes do clinicians review?. Invest. Ophthalmol. Vis. Sci. 2019;60(9):5506.

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

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Abstract

Purpose : Busy clinicians struggle with the efficiency of electronic health record systems (EHRs), but outpatient documentation and review practices by clinicians using EHRs are relatively unknown. In this study, we look at ophthalmologists’ patterns of note review in the EHR during outpatient follow-up office visits in ophthalmology.

Methods : Our dataset included typical office visits for 12 ophthalmologists in 6 different ophthalmology subspecialties (general ophthalmology, pediatrics, cornea, retina, neuro-ophthalmology, and oculoplastics) completed between January, 1, 2015 and December, 31, 2017 at the Oregon Health & Science University Casey Eye Institute. A typical visit was defined as a followup (non post-op) visit with a diagnosis code in the top 3 for that subspecialty. Audit log data accesses to notes different from the current office visit note were counted. These accesses were analyzed by user (ancillary staff, trainee, physician), by type of note (office visit vs. non-office visit), and by time of access (before, during, or after office visit). ANOVA comparisons with Tukey Honest Significant Differences were performed for the number of notes accessed by user and note type.

Results : Note accesses were analyzed for 7,138 office visits. On average, 2.9 ± 2.6 notes were accessed as part of documenting the visit: 1.5 ± 1.8 prior office visit notes and 1.3 ± 1.5 non-office visit notes. As shown in Table 1, attending ophthalmologists on average accessed the fewest notes (1.1 ± 1.8 notes) while staff accessed and trainees accessed more (1.8 ± 1.7 and 1.6 ± 3.7, respectively, p < 0.0001). These accesses represented a low proportion of total available notes in the EHR (2.6 ± 5.3% for physicians, 4.1 ± 6.4% for staff, and 2.8 ± 6.3% for trainees).

Conclusions : This study suggests that the vast majority of clinical data, specifically documentation from prior office visits, is not being reviewed by ophthalmologists. This has important implications for the quality and efficiency of clinical care delivery, and for the design of future EHR systems. Additional collaboration between ophthalmologists, informaticians, and policymakers will be required to create new EHR system designs that can best support the delivery of clinical care.

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

 

Table 1: The number of notes reviewed by each type of user. Overall, the attending physician reviews the least number of notes.

Table 1: The number of notes reviewed by each type of user. Overall, the attending physician reviews the least number of notes.

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