The Impact of a Location-Sensing Electronic Health Record on Clinician Efficiency and Accuracy: A Pilot Simulation Study

Abstract

Background Through the Health Information Technology for Economic and Clinical Health Act of 2009, the federal government invested $26 billion in electronic health records (EHRs) to improve physician performance and patient safety; however, these systems have not met expectations. One of the cited issues with EHRs is the human–computer interaction, as exhibited by the excessive number of interactions with the interface, which reduces clinician efficiency. In contrast, real-time location systems (RTLS)—technologies that can track the location of people and objects—have been shown to increase clinician efficiency. RTLS can improve patient flow in part through the optimization of patient verification activities. However, the data collected by RTLS have not been effectively applied to optimize interaction with EHR systems. Objectives We conducted a pilot study with the intention of improving the human–computer interaction of EHR systems by incorporating a RTLS. The aim of this study is to determine the impact of RTLS on process metrics (i.e., provider time, number of rooms searched to find a patient, and the number of interactions with the computer interface), and the outcome metric of patient identification accuracy Methods A pilot study was conducted in a simulated emergency department using a locally developed camera-based RTLS-equipped EHR that detected the proximity of subjects to simulated patients and displayed patient information when subjects entered the exam rooms. Ten volunteers participated in 10 patient encounters with the RTLS activated (RTLS-A) and then deactivated (RTLS-D). Each volunteer was monitored and actions recorded by trained observers. We sought a 50% improvement in time to locate patients, number of rooms searched to locate patients, and the number of mouse clicks necessary to perform those tasks. Results The time required to locate patients (RTLS-A = 11.9 ± 2.0 seconds vs. RTLS-D = 36.0 ± 5.7 seconds, p < 0.001), rooms searched to find patient (RTLS-A = 1.0 ± 1.06 vs. RTLS-D = 3.8 ± 0.5, p < 0.001), and number of clicks to access patient data (RTLS-A = 1.0 ± 0.06 vs. RTLS-D = 4.1 ± 0.13, p < 0.001) were significantly reduced with RTLS-A relative to RTLS-D. There was no significant difference between RTLS-A and RTLS-D for patient identification accuracy. Conclusion This pilot demonstrated in simulation that an EHR equipped with real-time location services improved performance in locating patients and reduced error compared with an EHR without RTLS. Furthermore, RTLS decreased the number of mouse clicks required to access information. This study suggests EHRs equipped with real-time location services that automates patient location and other repetitive tasks may improve physician efficiency, and ultimately, patient safety.

Impact of Patient Census and Admission Mortality on Pediatric Intensive Care Unit Attending Electronic Health Record Activity: A Preliminary Study

“…In the EHR literature, evaluating clinician efficiency is often the objective, utilizing the time spent or number of mouse clicks to complete a task to demonstrate the impact of an intervention. 27,28 Using time as a measure is understandable as decreasing the time spent performing EHR tasks can help improve the quality and safety of patient care, 29 improve clinician satisfaction, and allow more patients to be seen. 30 It is also an objective measure that demonstrates a targeted outcome.…”

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“…King et al 43 (2018) The impact of a location-sensing electronic health record on clinician efficiency and accuracy: a pilot simulation study. The time taken to locate patients (RTLS-A = 11.9 ± 2.0 s versus RTLS-D = 36.0 ± 5.7 s, P < 0.001), the number of rooms searched to find patients (RTLS-A = 1.0 ± 1.06 versus RTLS-D = 3.8 ± 0.5, P < 0.001), and the number of clicks to access patient data (RTLS-A = 1.0 ± 0.06 versus RTLS-D = 4.1 ± 0.13, P < 0.001) were significantly reduced with RTLS-A relative to RTLS-D.…”

Improving Documentation Using a Real-Time Location System in a Pediatric Emergency Department

“…24,25 King et al demonstrated the utility of an RTLSequipped EMR to improve performance in locating patients and increase physician efficiency interacting with the EMR. 26 Our project demonstrated an effective method to automate components of critical care documentation, which usually falls to the individual physician: the perception of time and proactively documenting that time in the chart.…”