Electronic health record (EHR) training program identifies a new tool to quantify the EHR time burden and improves providers’ perceived control over their workload in the EHR

Abstract

Objective To understand if providers who had additional electronic health record (EHR) training improved their satisfaction, decreased personal EHR-use time, and decreased turnaround time on tasks. Materials and Methods This pre-post study with no controls evaluated the impact of a supplemental EHR training program on a group of academic and community practice clinicians that previously had go-live group EHR training and 20 months experience using this EHR on self-reported data, calculated EHR time, and vendor-reported metrics. Results Providers self-reported significant improvements in their knowledge of efficiency tools in the EHR after training and doubled (significant) their preference list entries (mean pre = 38.1 [65.88], post = 63.5 [90.47], P < .01). Of the 7 EHR satisfaction variables, only 1 self-reported variable significantly improved after training: Control over my workload in the EHR (mean pre = 2.7 [0.96], post = 3.0 [1.04], P < .01). There was no significant decrease in their calculated EHR usage outside of clinic (mean pre = 0.39 [0.77] to post = 0.37 [0.48], P = .73). No significant difference was seen in turnaround time for patient calls (mean pre = 2.3 [2.06] days, post = 1.9 [1.76] days, P = .08) and results (mean before = 4.0 [2.79] days, after = 3.2 [2.33] days, P = .03). Discussion Multiple sources of data provide a holistic view of the provider experience in the EHR. This study suggests that individualized EHR training can improve the knowledge of EHR tools and satisfaction with their perceived control of EHR workload, however this did not translate into less Clinician Logged-In Outside Clinic (CLOC) time, a calculated metric, nor quicker turnaround on in box tasks. CLOC time emerged as a potential less-costly surrogate metric for provider satisfaction in EHR work than surveying clinicians. Further study is required to understand the cost-benefit of various interventions to decrease CLOC time. Conclusions This supplemental EHR training session, 20 months post go-live, where most participants elected to receive 2 or fewer sessions did significantly improve provider satisfaction with perceived control over their workload in the EHR, but it was not effective in decreasing EHR-use time outside of clinic. CLOC time, a calculated metric, could be a practical trackable surrogate for provider satisfaction (inverse correlation) with after-hours time spent in the EHR. Further study into interventions that decrease CLOC time and improve turnaround time to respond to inbox tasks are suggested next steps.

Physician Burnout and Timing of Electronic Health Record Use

“…11,12 Some of this difference may be attributed to differences in methodologies, as one study used self-report to determine afterhours work, 11 which might be an inaccurate estimate of objectively measured EHR time outside of clinic. 30 Another study normalized EHR time to a full-time physician and included weekday and weekend use in after-hours totals. 12 Nonetheless, physicians in this study had relatively low faceto-face time and patients-per-hour requirements compared with other organizations, which may have resulted in lower after-hours EHR use and limit the generalizability of our findings to settings with higher productivity requirements.…”

Measuring success: perspectives from three optimization programs on assessing impact in the age of burnout

“…In efforts to better understand and improve provider efficiency, the team at Stanford discovered that individualized training can improve providers’ self-perceived knowledge and use of EHR tools and also improve their satisfaction with their EHR workload. 8 , 9 It is well known that lack of mastery contributes to feelings of burnout, and thus it is logical that efforts to improve an individual’s mastery of the EHR may have a positive impact on their wellness. 10 While surveys can give a sense whether interventions make an impact, they are time-consuming to administer and are not always fully representative of a given population.…”

“…The Stanford team was able to identify that more after-hours time correlated with a worse provider EHR experience, and therefore was a prime candidate for an EHR-data-drive metric to track outcomes. 9 …”

“…The project at Stanford did not see a statistically significant improvement in WOW time for the providers that participated in the individualized training program, however, did see an improvement in the providers’ satisfaction with their workload. 9 This raises the question: how do we assess value as we are defining these metrics for success?…”

Effectiveness of Electronic Documentation: A Case Report

“…Participants in this study reported using shortcuts, such as completing electronic documentation at the end of their shifts rather than at the point-of-service (Rathert et al, 2017). DiAngi et al (2019) concluded that training to use an EHR system improved health care practitioners' perceived control of their workload while employing the EHR; however, health care practitioners continued to use the EHR outside of clinic hours. Jamieson et al (2016) concluded in a quantitative, blinded randomized crossover study that internal medicine physicians who used an EHR system had a greater quality of admission notes than those who used handwritten documentation.…”