The impact of an electronic health record transition on a glaucoma subspecialty practice

Abstract

Purpose: To assess the impact of an electronic health record (EHR) on patient experience, physician behavior, and clinic workflow in a glaucoma subspecialty clinic.

Design: Case-control (before/after) study.

Participants: One hundred thirty-one adult patients seeking treatment at a glaucoma subspecialty practice for a nonprocedural office visit who consented to direct observation and 273 patients whose progress through the clinic stations was timed.

Methods: Three time points relative to the EHR transition were evaluated: a 2-week period before the transition, a 2-week period at 2 weeks after the transition, and a 2-week period at 6 months after the transition. At each of these time points, detailed timing of physician actions during the doctor-patient encounter were measured, a survey of patient attitudes regarding their visit and the method of documentation was conducted, and time spent by patients in each of the major aspects of the visit (screening/testing, physician, waiting) was recorded.

Main outcome measures: Time spent by physicians on the clinical examination, computer, paper records, or multitasking; patient experience of their clinic visit; and time spent by patients at various clinic stations.

Results: Two weeks after the transition, physicians spent more time with patients overall compared with baseline (8.4 vs. 11.6 minutes), reviewing paper records (0.2 vs. 0.6 minutes), and on computer-related tasks (2.3 vs. 4.2 minutes). At 6 months after EHR transition, physicians also spent more time compared with baseline on the clinical examination (5.1 vs. 6.4 minutes). There was a relative decrease in the percentage of patient time spent waiting to see the physician, although patients' perceptions of their visit and the EHR remained largely unchanged. Annual clinic volumes also were unaffected by the new EHR.

Conclusions: There were changes in the physician-patient encounter that manifested within 2 weeks of EHR transition and then stabilized, suggesting that although an EHR transition is not without consequences, these can be measured early. Some of these findings, such as increased time dedicated to the clinical examination and the lack of change in patient perception after the switch, were unexpected. This study supports the contention that EHR implementation can be accomplished in an ophthalmology practice without compromising the efficiency of or patient satisfaction with the clinical encounter.