Evaluating electronic health record use among academic ophthalmologists

Abstract

Purpose : Ophthalmologists have high-volume practices that demand efficiency working with electronic health records (EHRs). Several EHR systems aggregate audit log data to generate metrics describing time spent on various tasks. These data can be used to better understand workflows and to capture after-hours EHR use, which has been associated with physician burnout and is not easily attainable by traditional time-motion studies. The aim of this study was to leverage these metrics to better understand ophthalmologists’ EHR use and identify strategies for optimizing efficiency.

Methods : EHR use data were obtained over 12 months (11/2018-10/2019) for 139 academic attending ophthalmologists at 5 institutions using the same vendor. Metrics included time spent on activities such as notes, orders, clinical review, and in-basket. After-hours use was approximated using metrics describing time in the system outside periods with scheduled appointments. Ophthalmologists’ use of EHR personalization features and efficiency tools were also analyzed. Linear mixed effects models were used to evaluate which factors were associated with decreased after-hours EHR use.

Results : Ophthalmologists (n=139) spent a mean (SD) of 76.3 (36.0) minutes (min) in the EHR per day (range: 3.4-201.2 min). On average, ophthalmologists spent the most time on notes per day (31.9 [21.0] min), followed by orders (11.6 [7.9] min) and clinical review (7.4 [5.5] min). Table 1 depicts metrics overall and by institution. Entering medication orders on the vendor’s mobile client was associated with significantly less time spent on after-hours EHR use (coefficient -13.40, p<0.001). Most other EHR efficiency tools were not associated with decreased after-hours EHR use (Table 2).

Conclusions : EHR audit log metrics can help quantify time spent on EHR activities both during appointments and after-hours. For a large group of academic ophthalmologists, enabling order entry on the mobile client was associated with reduced after-hours EHR use, whereas other tools did not demonstrate beneficial effects. These metrics can enable analyses providing insights into variations in EHR use and inform future efforts to promote efficiency of EHR use and physician satisfaction.

This is a 2020 ARVO Annual Meeting abstract.

 

Table 1. EHR use metrics for academic ophthalmologists at the University of California.

 

Table 2. Association of various factors with time spent in the EHR outside scheduled hours.