Abstract
Purpose :
Clinician documentation of each patient office visit results in accumulation of several notes in the electronic health record (EHR) over time, but it is unclear how frequently previously documented notes are accessed in follow-up visits. In this study, we examine ophthalmologists’ patterns of note review in the EHR during outpatient follow-up visits.
Methods :
Our dataset included typical office visits for 11 ophthalmologists in 6 ophthalmology subspecialties (general ophthalmology, pediatrics, cornea, retina, neuro-ophthalmology, and oculoplastics) completed between January 1, 2015 and December 31, 2018 at the Oregon Health & Science University Casey Eye Institute. A typical office visit was defined as a non-postoperative follow-up visit for one of the three most common diagnoses codes for that specialty. Audit log data accesses to notes during subsequent visits were counted. These accesses were analyzed by user access (ancillary staff vs. physician).
Results :
Note accesses were analyzed for 9,420 initial office visits. Overall, 5,720 patients had at least 1 follow-up visit with their provider. As shown in table 1, physicians and staff reviewed the initial note in 5,686 (99.7%) and 5,504 (96.4%) first follow-up visits, respectively. Accesses to the first note significantly decreased for both providers and ancillary over future follow-up visits, with 754 (4.9%) provider accesses and 30 (3.1%) staff accesses in the second follow-up visits. The latest access to the first note from initial documentation was on average 138.3 ± 219.7 days for ancillary staff and 123.4 ± 221.3 days for providers.
Conclusions :
This study suggests that an office visit note is generally not accessed after the subsequent office visit. These findings have important implications for clinical efficiency and the need for design of improved EHR systems.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.