Brief Report4000 Clicks: a productivity analysis of electronic medical records in a community hospital ED
Introduction
In 2009, the federal government passed into law the American Recovery and Reinvestment Act. This bill included the Health Information Technology (HIT) for Economic and Clinical Health Act, which provided for $19 billion in incentives to hospitals and physicians who demonstrate “meaningful use” of electronic medical records (EMRs) [1].
The use of EMRs has created much controversy in the health care industry. Health Information Technology companies promise such systems will reduce costs by as much as $100 billion annually, but results are inconclusive. In the face of rising costs, escalating demand, and downward price pressures, physician efficiency is imperative, and with a $150 to $200 million price tag for the software alone, the stakes are high for hospitals implementing these systems [2].
Given the federal mandate and economic incentives to hospitals to implement EMRs, there has been a rush to comply. System deployment amid such haste has not always been optimal.
The theoretical benefits to a well-functioning EMR system include improved communication and patient safety, seamless sharing of data via universal medical records, reduction of medical errors in order entry, reduction of unnecessary diagnostic testing, increased patient satisfaction, and more efficient third-party billing [2].
Experience with implementation of EMR in emergency departments (EDs) where, by definition, there can be large volumes of patients in need of expedient care has thus far met with mixed results [3], [4], [5], [6], [7], [8], [9], [10], [11], [12], [13], [14]. Unfortunately, many hospitals deploy network-wide EMR systems that fail to accommodate ED operational processes. It behooves us to systematically analyze the EMR process and tailor it to better meet the unique requirements of EDs.
We undertook a time study using an EMR system in our community hospital setting with an eye toward improving performance.
Section snippets
Materials and methods
An institutional review board waiver was obtained for this study.
Attending physicians, emergency medicine residents, and midlevel providers in our ED were tracked for a total of 30 hours. Each of the 16 participants recorded minutes per hour spent in 4 categories: direct patient contact, data entry and order entry, consultation and discussion with colleagues and staff, and review of test results and prior records. We felt it best to enroll participants during busy times because it is during
Results
Practitioners were observed completing selected operations using the McKesson Horizon Emergency Care V.10.3 EMR system at a community teaching hospital ED based on a single observation. The number of mouse clicks used to accomplish these tasks is displayed in Table 1. Table 2 shows extrapolated quantities of mouse clicks over a 10-hour shift, given patient velocities of 2, 2.12, and 2.5 per hour.
Participants recorded time spent in 4 categories: direct patient care, case review, discussion, and
Discussion
The findings in this study are consistent with other studies, which estimate the time spent on documentation to be 30% to 40% of a workday, with electronic charting taking 30% longer than paper charts [16]. Factors such as operating system speed, server/mainframe responsiveness, typing skills, user-friendliness of system, interruptions, extent of training, opportunity to delegate tasks, and various environmental attributes can influence data entry time. Efficient use of the EMR system will
References (25)
- et al.
Analyzing the impact of electronic charting on physician productivity and charge capture using statistical process control: a pilot study
Ann Emerg Med
(2012) The impact of a health information exchange on the management of patients in an urban academic emergency department: an observational study and cost analysis
Ann Emerg Med
(2012)The impact of electronic health record implementation on emergency department operations
Ann Emerg Med
(2012)- et al.
Prospective, randomized trial of template-assisted versus undirected written recording of physician records in the emergency department
Ann Emerg Med
(1999) - et al.
How do physicians and nurses spend their time in the emergency department?
Ann Emerg Med
(1998) Implementing electronic health records in the emergency department
J Emerg Med
(2010)Implementation of medical scribes in an academic emergency department: effect on emergency department throughput, clinical productivity, and emergency department physician professional fees
Ann Emerg Med
(2012)Electronic health records—where's the beef?
EMA
(2011)- Bukata R. When evaluating EMR efficacy, where's the beef? Emergency Physicians Monthly, November 2012;...
- et al.
Time motion study in a pediatric emergency department before and after computer physician order entry
Ann Emerg Med
(2009)
Electronic medical records and the efficiency of hospital emergency departments
Med Care Res Rev
Electronic health record use and the quality of ambulatory care in the United States
Arch Intern Med
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2021, International Journal of Medical InformaticsCitation Excerpt :The pace of innovation is very rapid with technology product generations often measured in months. However, medicine’s adoption of technology is beset with problems, the classic example being failure of electronic medical records to be user friendly, improve physician productivity and consistently improve patient care [1,2]. Notably, their introduction has had the opposite effect, with physicians reporting frustration and burnout [3,4].