Time Requirements of Paper-Based Clinical Workflows and After-Hours Documentation in a Multispecialty Academic Ophthalmology Practice

Baxter, Sally L.; Gali, Helena E.; Huang, Abigail E.; Millen, Marlene; El‐Kareh, Robert; Nudleman, Eric; Robbins, Shira L.; Heichel, Christopher W.D.; Camp, A.L.; Korn, Bobby S.; Lee, Jeffrey E.; Kikkawa, Don O.; Longhurst, Chris; Chiang, Michael F.; Hribar, Michelle R.; Ohno-Machado, Lucila

doi:10.1016/j.ajo.2019.03.014

Cited by 8 publications

(9 citation statements)

References 30 publications

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“…The efficacy of these interventions was evaluated by comparing timing outcomes for EHR use with those for paper charts, which have been previously reported. 32 Based on prior studies, [33][34][35] we anticipated that EHR use would be associated with significantly increased documentation time and decreased face-to-face communication time.…”

Section: Objectivesmentioning

confidence: 99%

“…All other activities (i.e., performing procedures, talking with trainees or staff about the patient) were categorized as "other." Consistent with previously published methodology, 32,33 if talking with the patient occurred simultaneously with another activity, only the nontalking activity was recorded. Therefore, "talking with the patient" was only recorded if the ophthalmologist was engaged in exclusive, face-to-face communication with the patient.…”

Section: Timing Metrics Based On Manual Time-motion Observationsmentioning

confidence: 99%

“…Training and quality control measures for manual time-motion observations in the outpatient ophthalmology setting have been previously described. 32 In summary, paired observations were conducted to ensure interobserver consistency in accurate timing and identification of clinical activities.…”

Section: Timing Metrics Based On Manual Time-motion Observationsmentioning

confidence: 99%

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Promoting Quality Face-to-Face Communication during Ophthalmology Encounters in the Electronic Health Record Era

et al. 2020

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Objective To evaluate informatics-enabled quality improvement (QI) strategies for promoting time spent on face-to-face communication between ophthalmologists and patients. Methods This prospective study involved deploying QI strategies during implementation of an enterprise-wide vendor electronic health record (EHR) in an outpatient academic ophthalmology department. Strategies included developing single sign-on capabilities, activating mobile- and tablet-based applications, EHR personalization training, creating novel workflows for team-based orders, and promoting problem-based charting to reduce documentation burden. Timing data were collected during 648 outpatient encounters. Outcomes included total time spent by the attending ophthalmologist on the patient, time spent on documentation, time spent on examination, and time spent talking with the patient. Metrics related to documentation efficiency, use of personalization features, use of team-based orders, and note length were also measured from the EHR efficiency portal and compared with averages for ophthalmologists nationwide using the same EHR. Results Time spent on exclusive face-to-face communication with patients initially decreased with EHR implementation (2.9 to 2.3 minutes, p = 0.005) but returned to the paper baseline by 6 months (2.8 minutes, p = 0.99). Observed participants outperformed national averages of ophthalmologists using the same vendor system on documentation time per appointment, number of customized note templates, number of customized order lists, utilization of team-based orders, note length, and time spent after-hours on EHR use. Conclusion Informatics-enabled QI interventions can promote patient-centeredness and face-to-face communication in high-volume outpatient ophthalmology encounters. By employing an array of interventions, time spent exclusively talking with the patient returned to levels equivalent to paper charts by 6 months after EHR implementation. This was achieved without requiring EHR redesign, use of scribes, or excessive after-hours work. Documentation efficiency can be achieved using interventions promoting personalization and team-based workflows. Given their efficacy in preserving face-to-face physician–patient interactions, these strategies may help alleviate risk of physician burnout.

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Section: Objectivesmentioning

confidence: 99%

Section: Timing Metrics Based On Manual Time-motion Observationsmentioning

confidence: 99%

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Promoting Quality Face-to-Face Communication during Ophthalmology Encounters in the Electronic Health Record Era

et al. 2020

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“…A substantial amount of time is spent on administrative tasks besides the direct patient care [47,48]. Consequently, an increasing number of physicians are affected by physical inactivity at the workplace [49,50] due to longer periods of computer work in the sitting posture.…”

Section: Introductionmentioning

confidence: 99%

A kinematic posture analysis of neurological assistants in their daily working practice-a pilot study

Bijanzadeh

Hermanns

Ellegast

et al. 2020

J Occup Med Toxicol

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Background The aim of this pilot study was to analyze postures during the work of neurologists with respect to their occupational activities. Methods A total data material of 64.8 h (3885.74 min) of nine (three m/six f) neurologists (assistant physicians) was collected. Kinematic data were collected using the CUELA system (electro-goniometry). In addition, the occupational tasks performed on-site were subject to a detailed objective activity analysis. All activities were assigned to the categories “Office activities” (I), “Measures on patients” (II) and “Other activities” (III). The angle values of each body region (evaluation parameters) were evaluated according to ergonomic ISO standards. Results Only 3.4% of the working hours were spent with (II), while 50.8% of time was spent with (I) and 45.8% with (III). All tasks of category (II) revealed an increased ergonomic risk to the head, neck, trunk and back areas. During category (I) especially neck and back movements in the sagittal plane showed higher ergonomic risk levels. Conclusion Despite frequently performed awkward body positions in (II), the ergonomic risk is considered as rather low, since the percentage time share totaled only 3.4%. As a result, “Office activities” have been detected as high predictor to cause stress load on the musculoskeletal system in the daily work of neurologists.

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“…This was facilitated by increased demands in the workplace for language skills, a growing flow of tourists abroad, etc. The situation did not change significantly even in times of crisis and Western sanctions: consumers still remain interested in traveling abroad and improving their communication skills with an emphasis on the future [1][2][3][4][5][6][7][8][9][10][11][12][13][14].…”

Section: Introductionmentioning

confidence: 99%

Features of Translation of Terms in Insurance Documentation

Goncharova¹,

Shemyakina²

2019

Proceedings of the First International Volga Region Conference on Economics, Humanities and Sports (FICEHS 2019)

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The gist of this article boils down to the need of integrating Russia into the global space, business development and the exchange of experience with international partners. The object of the study is English-language journalistic texts about the features of life insurance. The subject of the study -insurance terms found in the texts. The purpose of the work is to study insurance-specific terms in English and analyze their translation into Russian. Tasks of work: to define the essence of terms in general and terms in insurance in particular; highlight the features of insurance terminology; to analyze the basic methods of translation of terms; translate texts related to life insurance; identify difficult points in the translation of insurance terms; analyze the origin of terms, word formation; Choose the most suitable Russian equivalent. The hypothesis of the study: the authors consider the advantage of new technologies in translation of terms in insurance documentation at the present stage. Research methods: qualitative and quantitative analysis of the results in translation of terms in insurance documentation at the present stage. The result of the study: the advantage of new technologies in translation of terms in insurance documentation at the present stage. The material of the study was economic terms derived from a typical sample of sources representing the sphere of their functioning, namely, articles related to life insurance.

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Time Requirements of Paper-Based Clinical Workflows and After-Hours Documentation in a Multispecialty Academic Ophthalmology Practice

Cited by 8 publications

References 30 publications

Promoting Quality Face-to-Face Communication during Ophthalmology Encounters in the Electronic Health Record Era

Promoting Quality Face-to-Face Communication during Ophthalmology Encounters in the Electronic Health Record Era

A kinematic posture analysis of neurological assistants in their daily working practice-a pilot study

Features of Translation of Terms in Insurance Documentation

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