Use of electronic clinical documentation: time spent and team interactions

Abstract

Objective: To measure the time spent authoring and viewing documentation and to study patterns of usage in healthcare practice.

Design: Audit logs for an electronic health record were used to calculate rates, and social network analysis was applied to ascertain usage patterns. Subjects comprised all care providers at an urban academic medical center who authored or viewed electronic documentation.

Measurement: Rate and time of authoring and viewing clinical documentation, and associations among users were measured.

Results: Users spent 20-103 min per day authoring notes and 7-56 min per day viewing notes, with physicians spending less than 90 min per day total. About 16% of attendings' notes, 8% of residents' notes, and 38% of nurses' notes went unread by other users, and, overall, 16% of notes were never read by anyone. Viewing of notes dropped quickly with the age of the note, but notes were read at a low but measurable rate, even after 2 years. Most healthcare teams (77%) included a nurse, an attending, and a resident, and those three users' groups were the first to write notes during an admission. Limitations The limitations were restriction to a single academic medical center and use of log files without direct observation.

Conclusions: Care providers spend a significant amount of time viewing and authoring notes. Many notes are never read, and rates of usage vary significantly by author and viewer. While the rate of viewing a note drops quickly with its age, even after 2 years inpatient notes are still viewed.

Figure 1

Use of notes for clinical communication. For authors in each user group, the graph shows the percent of their notes that were viewed within 3 months by any user in the same or another user group. Viewing of a note by its author was not counted, and the ‘billing/HIM [health information management]’ user group was excluded from ‘anyone.’

Figure 2

Information-seeking behavior. For each viewer user group, the bars show how often such users sought out information authored by the same or another user group when it was available. Viewing of a note by its author was not counted.

Figure 3

Use of notes over time. Each point represents the probability of a physician (attending or resident) viewing a physician note on 1 day given that the note was authored some number of days in the past. Both scales are logarithmic. The probability of a note being viewed drops quickly but predictably over time.