Carayon Pascale, Wetterneck Tosha B, Alyousef Bashar, Brown Roger L, Cartmill Randi S, McGuire Kerry, Hoonakker Peter L T, Slagle Jason, Van Roy Kara S, Walker James M, Weinger Matthew B, Xie Anping, Wood Kenneth E
Center for Quality and Productivity Improvement, University of Wisconsin-Madison, 3130 Engineering Centers Building, 1550 Engineering Drive, Madison, WI 53706, United States; Department of Industrial and Systems Engineering, University of Wisconsin-Madison, 3270 Mechanical Engineering Building, 1513 University Avenue, Madison, WI 53706, United States.
Center for Quality and Productivity Improvement, University of Wisconsin-Madison, 3130 Engineering Centers Building, 1550 Engineering Drive, Madison, WI 53706, United States; Department of Industrial and Systems Engineering, University of Wisconsin-Madison, 3270 Mechanical Engineering Building, 1513 University Avenue, Madison, WI 53706, United States; School of Medicine and Public Health, University of Wisconsin-Madison, 600 Highland Avenue, Madison, WI 53792, United States.
Int J Med Inform. 2015 Aug;84(8):578-94. doi: 10.1016/j.ijmedinf.2015.04.002. Epub 2015 Apr 15.
To assess the impact of EHR technology on the work and workflow of ICU physicians and compare time spent by ICU resident and attending physicians on various tasks before and after EHR implementation.
EHR technology with electronic order management (CPOE, medication administration and pharmacy system) and physician documentation was implemented in October 2007.
We collected a total of 289 h of observation pre- and post-EHR implementation. We directly observed the work of residents in three ICUs (adult medical/surgical ICU, pediatric ICU and neonatal ICU) and attending physicians in one ICU (adult medical/surgical ICU).
EHR implementation had an impact on the time distribution of tasks as well as the temporal patterns of tasks. After EHR implementation, both residents and attending physicians spent more of their time on clinical review and documentation (40% and 55% increases, respectively). EHR implementation also affected the frequency of switching between tasks, which increased for residents (from 117 to 154 tasks per hour) but decreased for attendings (from 138 to 106 tasks per hour), and the temporal flow of tasks, in particular around what tasks occurred before and after clinical review and documentation. No changes in the time spent in conversational tasks or the physical care of the patient were observed.
The use of EHR technology has a major impact on ICU physician work (e.g., increased time spent on clinical review and documentation) and workflow (e.g., clinical review and documentation becoming the focal point of many other tasks). Further studies should evaluate the impact of changes in physician work on the quality of care provided.
评估电子健康记录（EHR）技术对重症监护病房（ICU）医生工作及工作流程的影响，并比较EHR实施前后ICU住院医师和主治医师在各项任务上所花费的时间。
2007年10月实施了具备电子医嘱管理（计算机化医嘱录入、用药管理和药房系统）及医生文档功能的EHR技术。
我们在EHR实施前后共收集了289小时的观察数据。我们直接观察了三个ICU（成人内科/外科ICU、儿科ICU和新生儿ICU）住院医师的工作以及一个ICU（成人内科/外科ICU）主治医师的工作。
EHR的实施对任务的时间分配以及任务的时间模式产生了影响。EHR实施后，住院医师和主治医师都将更多时间用于临床检查和文档记录（分别增加了40%和55%）。EHR的实施还影响了任务切换的频率，住院医师的任务切换频率增加（从每小时117项任务增至154项任务），而主治医师的任务切换频率降低（从每小时138项任务降至106项任务），同时也影响了任务的时间流程，尤其是临床检查和文档记录前后的任务情况。未观察到对话任务或患者身体护理所花费时间的变化。
EHR技术的使用对ICU医生的工作（如用于临床检查和文档记录的时间增加）和工作流程（如临床检查和文档记录成为许多其他任务的焦点）有重大影响。进一步的研究应评估医生工作变化对所提供护理质量的影响。
