Mathematical and Computational Science Program, Stanford University, Stanford, California, United States of America.
Department of Medicine, Stanford University, Stanford, California, United States of America.
PLoS One. 2019 Feb 6;14(2):e0205379. doi: 10.1371/journal.pone.0205379. eCollection 2019.
Amid growing rates of burnout, physicians report increasing electronic health record (EHR) usage alongside decreasing clinical facetime with patients. There exists a pressing need to improve physician-computer-patient interactions by streamlining EHR workflow. To identify interventions to improve EHR design and usage, we systematically characterize EHR activity among internal medicine residents at a tertiary academic hospital across various inpatient rotations and roles from June 2013 to November 2016. Logged EHR timestamps were extracted from Stanford Hospital's EHR system (Epic) and cross-referenced against resident rotation schedules. We tracked the quantity of EHR logs across 24-hour cycles to reveal daily usage patterns. In addition, we decomposed daily EHR time into time spent on specific EHR actions (e.g. chart review, note entry and review, results review).In examining 24-hour usage cycles from general medicine day and night team rotations, we identified a prominent trend in which night team activity promptly ceased at the shift's end, while day team activity tended to linger post-shift. Across all rotations and roles, residents spent on average 5.38 hours (standard deviation = 2.07) using the EHR. PGY1 (post-graduate year one) interns and PGY2+ residents spent on average 2.4 and 4.1 times the number of EHR hours on information review (chart, note, and results review) as information entry (note and order entry).Analysis of EHR event log data can enable medical educators and programs to develop more targeted interventions to improve physician-computer-patient interactions, centered on specific EHR actions.
在职业倦怠率不断上升的情况下，医生报告称，电子健康记录 (EHR) 的使用越来越多，而与患者的临床面对面交流却越来越少。通过简化 EHR 工作流程来改善医患计算机交互的需求迫在眉睫。为了确定改善 EHR 设计和使用的干预措施，我们系统地描述了 2013 年 6 月至 2016 年 11 月期间，一家三级学术医院的内科住院医师在各种住院轮班和角色中的 EHR 活动。从斯坦福医院的 EHR 系统（Epic）中提取了 EHR 时间戳，并与住院医师轮班表进行了交叉引用。我们跟踪了 24 小时周期内的 EHR 日志数量，以揭示日常使用模式。此外，我们将每日 EHR 时间分解为特定 EHR 操作（例如图表审查、记录输入和审查、结果审查）所花费的时间。在检查普通内科日夜团队轮班的 24 小时使用周期时，我们发现了一个明显的趋势，即夜班团队活动在轮班结束时立即停止，而白班团队活动往往在轮班结束后持续。在所有轮班和角色中，住院医师平均使用 EHR 时间为 5.38 小时（标准差=2.07）。PGY1（研究生一年级）实习医生和 PGY2+住院医师在信息审查（图表、记录和结果审查）上花费的 EHR 时间平均是信息输入（记录和医嘱输入）的 2.4 和 4.1 倍。EHR 事件日志数据的分析可以使医学教育工作者和项目能够制定更有针对性的干预措施，以改善医患计算机交互，重点关注特定的 EHR 操作。
