Time Spent on Dedicated Patient Care and Documentation Tasks Before and After the Introduction of a Structured and Standardized Electronic Health Record

Joukes, Erik; Abu‐Hanna, Ameen; Cornet, Ronald; Keizer, Nicolette F. de

doi:10.1055/s-0037-1615747

Cited by 86 publications

(78 citation statements)

References 8 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Third, our findings suggest that clinical practices and health-care systems must continue to explore technologies that facilitate inter-physician communication. Many researchers have shown that adoption of EHRs shifts the amount of time traditionally spent in a variety of aspects of patient care [12][13][14], an early manuscript demonstrated that emergency room physicians were eager to use electronic modalities to communicate with community-based colleagues [15], and several authors have demonstrated that use of an EHR can improve the quality and efficiency of discharges from inpatient services and of communications between physicians, nurses, and pharmacists [16][17][18]. However, only one study to our knowledge has shown that adoption of electronic technologies-specifically, a computerized referral platform-enhances quality or frequency of inter-physician communications [19], and our data may support that notion.…”

Section: Discussionmentioning

confidence: 99%

Communication with general practitioners: a survey of spinal cord injury physicians’ perspectives

Stillman

Gustafson

Fried

et al. 2019

Spinal Cord Ser Cases

View full text Add to dashboard Cite

Study design An online questionnaire. Objectives To gauge spinal cord injury (SCI) specialists' assessment of their communications with general practitioners (GPs). To determine whether economic or health-care system-related factors enhance or inhibit such communication. Setting A collaboration of co-authors from a health-care system. Methods An online survey interrogating a number of aspects of communication between SCI specialists and GPs was developed, distributed, and made available for 4 months. Responses were analyzed for the entire cohort then according to descriptions of participants' home nations' economies and the type of health-care delivery systems in which they work. Results A total of 88 responses were submitted. The majority (64%) were from nations with developed economies, a plurality (47.1%) were from countries that offer universal health coverage, and half used a combination of paper and electronic health records. A majority of respondents (61.8%) reported routinely communicating with their patients' GPs, but most (53.4%) rated those communications as only "fair". The most commonly listed barriers to communication with GPs were lack of time (46.3%) and a perceived lack of receptivity by GPs (26.9%). Nearly all respondents (91.6%) believed that the care they provide would be enhanced by improved communication with GPs. Participants who used electronic means of communication were more likely to communicate with GPs and to describe those interactions as "positive". Conclusions Although there are a number of barriers to communication between SCI specialists and GPs, most SCI specialists are eager for such inter-physician communication and believe it would enhance their care they deliver.

show abstract

Section: Discussionmentioning

confidence: 99%

Communication with general practitioners: a survey of spinal cord injury physicians’ perspectives

Stillman

Gustafson

Fried

et al. 2019

Spinal Cord Ser Cases

View full text Add to dashboard Cite

show abstract

“…7 Despite documentation becoming more comprehensive with the switch from paper to electronic medical records, it has also likely increased the amount of time spent documenting. [8][9][10] The problem is amplified when treating patients with chronic conditions, for whom providing guideline-based care in all scenarios would take more time than the practicing physician has available for patient care. 11 Considering 67.7% of patients 65 years or older have at least two chronic conditions in 2015, this issue is particularly significant with the aging U.S. population.…”

Section: Background and Significancementioning

confidence: 99%

Electronic Health Record Documentation Patterns of Recorded Primary Care Visits Focused on Complex Communication: A Qualitative Study

et al. 2019

View full text Add to dashboard Cite

Background In a time-constrained clinical environment, physicians cannot feasibly document all aspects of an office visit in the electronic health record (EHR). This is especially true for patients with multiple chronic conditions requiring complex clinical reasoning. It is unclear how physicians prioritize the documentation of health information in the EHR. Objective The goal of this study is to examine documentation tradeoffs made by physicians when caring for complex patients by comparing the content of office visit conversations with resulting EHR documentation. Methods We used grounded theory method of qualitative analysis to assess emergent themes in the transcripts of 10 office visits, and then compared the themes to documentation in the EHR. Differences between discussion and subsequent documentation of social and emotional health topics and each of the other key categories were compared using the Wilcoxon signed-rank test. Results The categories that emerged included “chronic conditions,” “acute/new problems,” “disease prevention,” and “social and emotional health.” We found that when social and emotional topics were discussed in the office visit, it was documented in the medical record only 30.6% of the time. Chronic conditions, acute/new problems, and disease prevention were documented in the EHR between 87.5 and 91.7% of the time after discussion. The differences between discussion and documentation of social and emotional topics were significantly greater than the differences for chronic conditions, acute/new problems, and disease prevention (all p < 0.05). Conclusion Social and emotional factors, while extremely relevant to health management, are less likely than medical concerns to be documented after discussion in an office visit. This lack of documentation may hinder interdisciplinary communication between teams informing individualized therapeutic decisions during acute care handoffs, such as outpatient to inpatient care.

show abstract

“…1,2 Many physicians have reported generally positive experiences with EHRs, 3 but despite the documented benefits of such systems, 4 EHR systems are also associated with unintended increases in physician workload and documentation times, [5][6][7][8] hospital inefficiencies, 9 and decreased time spent delivering direct patient care. [10][11][12][13] EHR-related increases in physicians' documentation and billing workload are key contributors to physician dissatisfaction in the field of neurology, where physician burnout is high relative to other specialties, [14][15][16] thereby potentially leading to compromises in patient-care quality. 17,18 As a specialty, neurology entails high-EHR utilization due to several factors.…”

Section: Background and Significancementioning

confidence: 99%

Neurological Dashboards and Consultation Turnaround Time at an Academic Medical Center

et al. 2019

View full text Add to dashboard Cite

Background Neurologists perform a significant amount of consultative work. Aggregative electronic health record (EHR) dashboards may help to reduce consultation turnaround time (TAT) which may reflect time spent interfacing with the EHR. Objectives This study was aimed to measure the difference in TAT before and after the implementation of a neurological dashboard. Methods We retrospectively studied a neurological dashboard in a read-only, web-based, clinical data review platform at an academic medical center that was separate from our institutional EHR. Using our EHR, we identified all distinct initial neurological consultations at our institution that were completed in the 5 months before, 5 months after, and 12 months after the dashboard go-live in December 2017. Using log data, we determined total dashboard users, unique page hits, patient-chart accesses, and user departments at 5 months after go-live. We calculated TAT as the difference in time between the placement of the consultation order and completion of the consultation note in the EHR. Results By April 30th in 2018, we identified 269 unique users, 684 dashboard page hits (median hits/user 1.0, interquartile range [IQR] = 1.0), and 510 unique patient-chart accesses. In 5 months before the go-live, 1,434 neurology consultations were completed with a median TAT of 2.0 hours (IQR = 2.5) which was significantly longer than during 5 months after the go-live, with 1,672 neurology consultations completed with a median TAT of 1.8 hours (IQR = 2.2; p = 0.001). Over the following 7 months, 2,160 consultations were completed and median TAT remained unchanged at 1.8 hours (IQR = 2.5). Conclusion At a large academic institution, we found a significant decrease in inpatient consult TAT 5 and 12 months after the implementation of a neurological dashboard. Further study is necessary to investigate the cognitive and operational effects of aggregative dashboards in neurology and to optimize their use.

show abstract

Time Spent on Dedicated Patient Care and Documentation Tasks Before and After the Introduction of a Structured and Standardized Electronic Health Record

Cited by 86 publications

References 8 publications

Communication with general practitioners: a survey of spinal cord injury physicians’ perspectives

Communication with general practitioners: a survey of spinal cord injury physicians’ perspectives

Electronic Health Record Documentation Patterns of Recorded Primary Care Visits Focused on Complex Communication: A Qualitative Study

Neurological Dashboards and Consultation Turnaround Time at an Academic Medical Center

Contact Info

Product

Resources

About