Brief Report
4000 Clicks: a productivity analysis of electronic medical records in a community hospital ED

https://doi.org/10.1016/j.ajem.2013.06.028Get rights and content

Abstract

Objective

We evaluate physician productivity using electronic medical records in a community hospital emergency department.

Methods

Physician time usage per hour was observed and tabulated in the categories of direct patient contact, data and order entry, interaction with colleagues, and review of test results and old records.

Results

The mean percentage of time spent on data entry was 43% (95% confidence interval, 39%-47%). The mean percentage of time spent in direct contact with patients was 28%. The pooled weighted average time allocations were 44% on data entry, 28% in direct patient care, 12% reviewing test results and records, 13% in discussion with colleagues, and 3% on other activities. Tabulation was made of the number of mouse clicks necessary for several common emergency department charting functions and for selected patient encounters. Total mouse clicks approach 4000 during a busy 10-hour shift.

Conclusion

Emergency department physicians spend significantly more time entering data into electronic medical records than on any other activity, including direct patient care. Improved efficiency in data entry would allow emergency physicians to devote more time to patient care, thus increasing hospital revenue.

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

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