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. 2018 Jan 1;25(1):40-46.
doi: 10.1093/jamia/ocx098.

Secondary use of electronic health record data for clinical workflow analysis

Michelle R Hribar  1 , Sarah Read-Brown  2 , Isaac H Goldstein  2 , Leah G Reznick  2 , Lorinna Lombardi  2 , Mansi Parikh  2 , Winston Chamberlain  2 , Michael F Chiang  1   2
Affiliations

Secondary use of electronic health record data for clinical workflow analysis

Michelle R Hribar et al. J Am Med Inform Assoc. .

Abstract

Objective: Outpatient clinics lack guidance for tackling modern efficiency and productivity demands. Workflow studies require large amounts of timing data that are prohibitively expensive to collect through observation or tracking devices. Electronic health records (EHRs) contain a vast amount of timing data - timestamps collected during regular use - that can be mapped to workflow steps. This study validates using EHR timestamp data to predict outpatient ophthalmology clinic workflow timings at Oregon Health and Science University and demonstrates their usefulness in 3 different studies.

Materials and methods: Four outpatient ophthalmology clinics were observed to determine their workflows and to time each workflow step. EHR timestamps were mapped to the workflow steps and validated against the observed timings.

Results: The EHR timestamp analysis produced times that were within 3 min of the observed times for >80% of the appointments. EHR use patterns affected the accuracy of using EHR timestamps to predict workflow times.

Discussion: EHR timestamps provided a reasonable approximation of workflow and can be used for workflow studies. They can be used to create simulation models, analyze EHR use, and quantify the impact of trainees on workflow.

Conclusion: The secondary use of EHR timestamp data is a valuable resource for clinical workflow studies. Sample timestamp data files and algorithms for processing them are provided and can be used as a template for more studies in other clinical specialties and settings.

Keywords: computer simulation; electronic health records; secondary use of electronic health record data; workflow.

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Figures

Figure 1.
Figure 1.
Algorithm for calculating workflow timings from EHR timestamps. This algorithm describes the steps for calculating the timings for workflow: initial staff and provider exams, additional workflow step (ie, dilation), wait time.
Figure 2.
Figure 2.
Algorithm for calculating EHR use from EHR timestamps. This algorithm describes the steps for calculating the duration of time of EHR use by staff and providers for an outpatient appointment.
Figure 3.
Figure 3.
Density plots of EHR calculated and observed provider exam times. The shapes of the density plots for the EHR and observed exam times were similar, and there was significant overlap of the 2 density plots.
Figure 4.
Figure 4.
Histogram plots of the difference between the observed and EHR calculated provider EHR use times. For the bulk of the encounters, the difference between the observed and calculated EHR use times was close to zero. In general, the calculated EHR use times underestimated the observed use times.
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References

    1. Blumenthal D, Collins S. Health care coverage under the Affordable Care Act: a progress report. N Engl J Med. 2014;371:275–81. - PubMed
    1. Hu P, Reuben DB. Effects of managed care on the length of time that elderly patients spend with physicians during ambulatory visits: National Ambulatory Medical Care Survey. Med Care. 2002;40:606–13. - PubMed
    1. Shea S, Hripcsak G. Accelerating the use of electronic health records in physician practices. N Engl J Med. 2010;362:192–95. - PubMed
    1. Chiang MF, Boland MV, Margolis JW, et al. . Adoption and perceptions of electronic health record systems by ophthalmologists: an American Academy of Ophthalmology survey. Ophthalmology. 2008;115:1591–97. - PubMed
    1. Boland MV, Chiang MF, Lim MC, et al. . Adoption of electronic health records and preparations for demonstrating meaningful use: an American Academy of Ophthalmology survey. Ophthalmology. 2013;120:1702–10. - PubMed

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