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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)
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.
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.
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).
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.
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