Joukes Erik, Abu-Hanna Ameen, Cornet Ronald, de Keizer Nicolette F
Appl Clin Inform. 2018 Jan;9(1):46-53. doi: 10.1055/s-0037-1615747. Epub 2018 Jan 17.
Physicians spend around 35% of their time documenting patient data. They are concerned that adopting a structured and standardized electronic health record (EHR) will lead to more time documenting and less time for patient care, especially during consultations.
This study measures the effect of the introduction of a structured and standardized EHR on documentation time and time for dedicated patient care during outpatient consultations.
We measured physicians' time spent on four task categories during outpatient consultations: documentation, patient care, peer communication, and other activities. Physicians covered various specialties from two university hospitals that jointly implemented a structured and standardized EHR. Preimplementation, one hospital used a legacy-EHR, and one primarily paper-based records. The same physicians were observed 2 to 6 months before and 6 to 8 months after implementation.We analyzed consultation duration, and percentage of time spent on each task category. Differences in time distribution before and after implementation were tested using multilevel linear regression.
We observed 24 physicians (162 hours, 439 consultations). We found no significant difference in consultation duration or number of consultations per hour. In the legacy-EHR center, we found the implementation associated with a significant decrease in time spent on dedicated patient care (-8.5%). In contrast, in the previously paper-based center, we found a significant increase in dedicated time spent on documentation (8.3%) and decrease in time on combined patient care and documentation (-4.6%). The effect on dedicated documentation time significantly differed between centers.
Implementation of a structured and standardized EHR was associated with 8.5% decrease in time for dedicated patient care during consultations in one center and 8.3% increase in dedicated documentation time in another center. These results are in line with physicians' concerns that the introduction of a structured and standardized EHR might lead to more documentation burden and less time for dedicated patient care.
医生大约花费35%的时间记录患者数据。他们担心采用结构化和标准化的电子健康记录（EHR）会导致记录时间增加，而用于患者护理的时间减少，尤其是在会诊期间。
本研究测量引入结构化和标准化EHR对门诊会诊期间记录时间和专门用于患者护理的时间的影响。
我们测量了医生在门诊会诊期间花费在四类任务上的时间：记录、患者护理、同行交流和其他活动。医生涵盖了两家联合实施结构化和标准化EHR的大学医院的各个专科。在实施前，一家医院使用传统EHR，另一家主要使用纸质记录。在实施前2至6个月和实施后6至8个月对相同的医生进行观察。我们分析了会诊时长以及在每个任务类别上花费的时间百分比。使用多级线性回归测试实施前后时间分布的差异。
我们观察了24名医生（162小时，439次会诊）。我们发现会诊时长或每小时会诊次数没有显著差异。在传统EHR中心，我们发现实施与专门用于患者护理的时间显著减少（-8.5%）相关。相比之下，在之前使用纸质记录的中心，我们发现专门用于记录的时间显著增加（8.3%），而用于患者护理和记录的总时间减少（-4.6%）。两个中心对专门记录时间的影响显著不同。
在一个中心，结构化和标准化EHR的实施与会诊期间专门用于患者护理的时间减少8.5%相关，而在另一个中心，专门记录时间增加8.3%。这些结果与医生的担忧一致，即引入结构化和标准化EHR可能会导致更多的记录负担和更少的专门用于患者护理的时间。
