TY - JOUR
T1 - Efficiency of Emergency Physicians
T2 - Insights from an Observational Study using EHR Log Files
AU - Kannampallil, Thomas G.
AU - Denton, Courtney A.
AU - Shapiro, Jason S.
AU - Patel, Vimla L.
N1 - Funding Information:
This research is supported by grant #R01HS022670 from the Agency for Healthcare Research and Quality (AHRQ). The content is sole responsibility of the authors and does not necessarily represent the official views of the AHRQ.
Publisher Copyright:
© 2018 Schattauer.
PY - 2018/1/1
Y1 - 2018/1/1
N2 - Objective With federal mandates and incentives since the turn of this decade, electronic health records (EHR) have been widely adopted and used for clinical care. Over the last several years, we have seen both positive and negative perspectives on its use. Using an analysis of log files of EHR use, we investigated the nature of EHR use and their effect on an emergency department's (ED) throughput and efficiency. Methods EHR logs of time spent by attending physicians on EHR-based activities over a 6-week period (n = 2,304 patients) were collected. For each patient encounter, physician activities in the EHR were categorized into four activities: documentation, review, orders, and navigation. Four ED-based performance metrics were also captured: door-to-provider time, door-to-doctor time, door-to-disposition time, and length of stay (LOS). Association between the four EHR-based activities and corresponding ED performance metrics were evaluated. Results We found positive correlations between physician review of patient charts, and door-to-disposition time (r = 0.43, p < 0.05), and with LOS (r = 0.48, p < 0.05). There were no statistically significant associations between any of the other performance metrics and EHR activities. Conclusion The results highlight that longer time spent on reviewing information on the EHR is potentially associated with decreased ED throughput efficiency. Balancing these competing goals is often a challenge of physicians, and its implications for patient safety is discussed.
AB - Objective With federal mandates and incentives since the turn of this decade, electronic health records (EHR) have been widely adopted and used for clinical care. Over the last several years, we have seen both positive and negative perspectives on its use. Using an analysis of log files of EHR use, we investigated the nature of EHR use and their effect on an emergency department's (ED) throughput and efficiency. Methods EHR logs of time spent by attending physicians on EHR-based activities over a 6-week period (n = 2,304 patients) were collected. For each patient encounter, physician activities in the EHR were categorized into four activities: documentation, review, orders, and navigation. Four ED-based performance metrics were also captured: door-to-provider time, door-to-doctor time, door-to-disposition time, and length of stay (LOS). Association between the four EHR-based activities and corresponding ED performance metrics were evaluated. Results We found positive correlations between physician review of patient charts, and door-to-disposition time (r = 0.43, p < 0.05), and with LOS (r = 0.48, p < 0.05). There were no statistically significant associations between any of the other performance metrics and EHR activities. Conclusion The results highlight that longer time spent on reviewing information on the EHR is potentially associated with decreased ED throughput efficiency. Balancing these competing goals is often a challenge of physicians, and its implications for patient safety is discussed.
KW - EHR logfiles
KW - emergency department
KW - meaningful use
KW - physician performance
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U2 - 10.1055/s-0037-1621705
DO - 10.1055/s-0037-1621705
M3 - Article
AN - SCOPUS:85053338446
SN - 1869-0327
VL - 9
SP - 99
EP - 104
JO - Applied Clinical Informatics
JF - Applied Clinical Informatics
IS - 1
M1 - 170061ra
ER -