Abstract
Purpose :
Problem-based charting (PBC) is a documentation method that integrates note writing and problem list management and has shown improved note quality and problem list utilization in inpatient settings. Ophthalmologists at OHSU who switched to PBC have anecdotally reported reduced time documenting. This study measures the effects of PBC on documentation time.
Methods :
Documentation time was measured using EHR timestamp and audit log data extracted from OHSU’s datamart for providers who transitioned to PBC (2 retina and 1 glaucoma). All visits with complete timing data were included. Visits that occurred 4 months before and after transition to PBC were analyzed, along with a transition period when they first began using a PBC documentation template. Total documentation time before, during, and after visits were calculated for each provider and for technicians to account for varying numbers of patients per day. Appointment length, defined as time from patient checkin to checkout, was calculated.
Results :
On average, the three providers spent 21.8 +/- 14.1 [MC1] minutes/patient documenting before, 23.4 +/- 16.6 minutes/patient while transitioning, and 20.2 +/- 16.2 minutes/patient after switching to PBC. Technicians spent a mean of 14.1 +/-17.8, 16.6 +/- 23.8, and 16.2 +/-20.4 minutes/patient before, during the transition, and after switching to PBC respectively.
Conclusions :
Problem-based charting shows promise in increasing documentation efficiency for providers in outpatient ophthalmology, which could improve clinical efficiency and reduce provider burnout.
This is a 2020 ARVO Annual Meeting abstract.