Vanderbilt University Medical Center, Nashvile, Tennessee; and
The Overhage Group, Zionsville, Indiana.
Pediatrics. 2020 Dec;146(6). doi: 10.1542/peds.2019-4017. Epub 2020 Nov 2.
The time providers spend using their electronic health records (EHRs) delivering care and its potential impact on patient care are of concern for the health care system. In studies to date, researchers have focused on providers who primarily care for adults. Scant information exists for pediatricians. Given this gap, it is important to quantify EHR activity for this group.
We studied pediatricians practicing in US-based ambulatory practices using the Cerner Millennium EHR by extracting data from software log files in the Lights On Network for the calendar year 2018 and summarizing the time spent on each of 13 clinically-focused EHR functions according to clinical specialty.
Our data included >20 million encounters by almost 30 thousand physicians from 417 health systems. Pediatric physicians spent an average of 16 minutes per encounter using their EHR. Chart review (31%), documentation (31%), and ordering (13%) functions accounted for most of the time. The distribution of time spent by providers using their EHR is highly variable within subspecialty but is similar across specialties. Because of data limitations, we were unable to examine geographic or health system-specific variation.
Pediatricians, like physicians who care for adults, spend a large portion of their day using their EHR. Additionally, although chart review and documentation accounted for 62% of the activity, as in previously published studies, in our study, we found that chart review accounted for half of that time. Wide variation suggests opportunities to optimize both the processes of entering information and searching for patient data within the EHR.
医疗服务提供者在使用电子健康记录(EHR)提供医疗服务方面所花费的时间及其对患者护理的潜在影响,是医疗保健系统关注的问题。在迄今为止的研究中,研究人员主要关注的是主要照顾成年人的医疗服务提供者。针对儿科医生的相关信息则很少。鉴于这一差距,量化这一群体的 EHR 活动非常重要。
我们使用 Cerner Millennium EHR 通过从 2018 年 Lights On Network 的软件日志文件中提取数据,对在美国开展的基于门诊实践的儿科医生进行了研究,并根据临床专业总结了他们在 13 项以临床为重点的 EHR 功能上花费的时间。
我们的数据包括来自 417 个医疗系统的近 3 万名医生的超过 2000 万次就诊。儿科医生每次使用 EHR 平均花费 16 分钟。查阅图表(31%)、记录文档(31%)和下达医嘱(13%)的功能占据了大部分时间。在子专业内,使用 EHR 的医疗服务提供者的时间分配差异很大,但在各专业之间差异相似。由于数据限制,我们无法检查地理位置或医疗系统的具体变化。
儿科医生与照顾成人的医生一样,每天花费大量时间使用 EHR。此外,尽管查阅图表和记录文档占活动的 62%,但与之前发表的研究一样,在我们的研究中,我们发现查阅图表占了其中的一半时间。广泛的差异表明有机会优化在 EHR 中输入信息和搜索患者数据的流程。