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. 2019 Jun;126(6):783-791.
doi: 10.1016/j.ophtha.2019.01.011. Epub 2019 Jan 18.

Changes in Electronic Health Record Use Time and Documentation over the Course of a Decade

Isaac H Goldstein  1 , Thomas Hwang  1 , Sowjanya Gowrisankaran  2 , Ryan Bales  1 , Michael F Chiang  3 , Michelle R Hribar  4
Affiliations

Changes in Electronic Health Record Use Time and Documentation over the Course of a Decade

Isaac H Goldstein et al. Ophthalmology. 2019 Jun.

Abstract

Purpose: With the current wide adoption of electronic health records (EHRs) by ophthalmologists, there are widespread concerns about the amount of time spent using the EHR. The goal of this study was to examine how the amount of time spent using EHRs as well as related documentation behaviors changed 1 decade after EHR adoption.

Design: Single-center cohort study.

Participants: Six hundred eighty-five thousand three hundred sixty-one office visits with 70 ophthalmology providers.

Methods: We calculated time spent using the EHR associated with each individual office visit using EHR audit logs and determined chart closure times and progress note length from secondary EHR data. We tracked and modeled how these metrics changed from 2006 to 2016 with linear mixed models.

Main outcome measures: Minutes spent using the EHR associated with an office visit, chart closure time in hours from the office visit check-in time, and progress note length in characters.

Results: Median EHR time per office visit in 2006 was 4.2 minutes (interquartile range [IQR], 3.5 minutes), and increased to 6.4 minutes (IQR, 4.5 minutes) in 2016. Median chart closure time was 2.8 hours (IQR, 21.3 hours) in 2006 and decreased to 2.3 hours (IQR, 18.5 hours) in 2016. In 2006, median note length was 1530 characters (IQR, 1435 characters) and increased to 3838 characters (IQR, 2668.3 characters) in 2016. Linear mixed models found EHR time per office visit was 31.9±0.2% (P < 0.001) greater from 2014 through 2016 than from 2006 through 2010, chart closure time was 6.7±0.3 hours (P < 0.001) shorter from 2014 through 2016 versus 2006 through 2010, and note length was 1807.4±6.5 characters (P < 0.001) longer from 2014 through 2016 versus 2006 through 2010.

Conclusions: After 1 decade of use, providers spend more time using the EHR for an office visit, generate longer notes, and close the chart faster. These changes are likely to represent increased time and documentation pressure for providers. Electronic health record redesign and new documentation regulations may help to address these issues.

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Figures

Figure 1.
Figure 1.
Graph showing changes in electronic health record (EHR) time per office visit over the course of 1 decade. Meaningful Use (MU) periods are labeled. A total of 13 312 data points were considered outliers and were excluded from the figure.
Figure 2.
Figure 2.
Graph showing changes in chart closure time over the course of a decade. Meaningful Use (MU) periods are labeled. A total of 53 433 data points were considered outliers and were excluded from the figure.
Figure 3.
Figure 3.
Graph showing changes in progress note length over the course of a decade. Meaningful Use (MU) periods are labeled. A total of 11676 data points were considered outliers and were excluded from the figure.
See this image and copyright information in PMC

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