School of Public Health, University of Alberta, Edmonton, AB, Canada.
Office of Research Services and School of Business, MacEwan University, Edmonton, AB, Canada.
J Med Internet Res. 2024 Apr 29;26:e53122. doi: 10.2196/53122.
Health care organizations implement electronic health record (EHR) systems with the expectation of improved patient care and enhanced provider performance. However, while these technologies hold the potential to create improved care and system efficiencies, they can also lead to unintended negative consequences, such as patient safety issues, communication problems, and provider burnout.
This study aims to document metrics related to the In Basket communication hub (time in In Basket per day, time in In Basket per appointment, In Basket messages received per day, and turnaround time) of the EHR system implemented by Alberta Health Services, the province-wide health delivery system called Connect Care (Epic Systems). The objective was to identify how a newly implemented EHR system was used, the timing of its use, and the duration of use specifically related to In Basket activities.
A descriptive study was conducted. Due to the diversity of specialties, the providers were grouped into medical and surgical based on previous similar studies. The participants were further subgrouped based on their self-reported clinical full-time equivalent (FTE ) measure. This resulted in 3 subgroups for analysis: medical FTE <0.5, medical FTE >0.5, and surgical (all of whom reported FTE >0.5). The analysis was limited to outpatient clinical interactions and explicitly excluded inpatient activities.
A total of 72 participants from 19 different specialties enrolled in this study. The providers had, on average, 8.31 appointments per day during the reporting periods. The providers received, on average, 21.93 messages per day, and they spent 7.61 minutes on average in the time in In Basket per day metric and 1.84 minutes on average in the time in In Basket per appointment metric. The time for the providers to mark messages as done (turnaround time) was on average 11.45 days during the reporting period. Although the surgical group had, on average, approximately twice as many appointments per scheduled day, they spent considerably less connected time (based on almost all time metrics) than the medical group. However, the surgical group took much longer than the medical group to mark messages as done (turnaround time).
We observed a range of patterns with no consistent direction. There does not seem to be evidence of a "learning curve," which would have shown a consistent reduction in time spent on the system over time due to familiarity and experience. While this study does not show how the included metrics could be used as predictors of providers' satisfaction or feelings of burnout, the use trends could be used to start discussions about future Canadian studies needed in this area.
医疗机构实施电子健康记录（EHR）系统，期望改善患者护理和提高医护人员绩效。然而，尽管这些技术有可能创造更好的护理和系统效率，但也可能导致意想不到的负面后果，例如患者安全问题、沟通问题和医护人员倦怠。
本研究旨在记录艾伯塔省卫生服务（全省医疗服务系统，称为 Connect Care（Epic 系统））实施的 In Basket 通信中心相关指标（每天在 In Basket 中花费的时间、每次预约在 In Basket 中花费的时间、每天收到的 In Basket 消息数和周转时间）。目的是确定新实施的 EHR 系统的使用方式、使用时间和具体与 In Basket 活动相关的使用时长。
本研究采用描述性研究方法。由于专业的多样性，医护人员根据之前的类似研究被分为医疗和外科。参与者根据其自我报告的临床全职等效（FTE）测量值进一步分为亚组。这导致了 3 个亚组进行分析：医疗 FTE <0.5、医疗 FTE >0.5 和外科（所有报告的 FTE >0.5）。分析仅限于门诊临床交互，明确排除了住院活动。
共有来自 19 个不同专业的 72 名参与者参加了这项研究。在报告期间，医护人员平均每天有 8.31 次预约。他们平均每天收到 21.93 条消息，每天在 In Basket 中花费 7.61 分钟，每次预约在 In Basket 中花费 1.84 分钟。医护人员标记消息已完成（周转时间）的时间平均为报告期内的 11.45 天。尽管外科组平均每天的预约数几乎是医疗组的两倍，但他们花费的连接时间（基于几乎所有时间指标）明显较少。然而，外科组完成消息标记的时间（周转时间）比医疗组长得多。
我们观察到了一系列模式，但没有一致的方向。似乎没有证据表明存在“学习曲线”，因为随着时间的推移，由于熟悉和经验，系统使用时间不会持续减少。虽然本研究并未表明所包括的指标如何可作为医护人员满意度或倦怠感的预测指标，但使用趋势可用于启动有关该领域未来加拿大研究的讨论。
