As the role of EHRs increase, training programs should be aware of how EHRs might affect resident responsibilities and learning opportunities.Ĭorresponding Author: Jeffrey Chi, MD, Department of Internal Medicine, Stanford University School of Medicine, 300 Pasteur Dr, MC 5209, Stanford, CA 94305 ( Online: December 7, 2015. Responsibility for larger volumes of information, new documentation requirements, and poor user-interfaces could be contributing to increased EHR activity, highlighting opportunities to streamline workflow and directions for future study. Of note, this study was limited to a single specialty at 1 institution without direct observation. ![]() This supports anecdotal observations that the traditional model of gathering overnight updates at the bedside has evolved into electronic “prerounding.” 1 While computer use decreased during teaching conferences, the persistent level of activity highlights the balance between education and patient care. The distribution of activity is noteworthy, with morning peaks occurring when house staff have traditionally examined patients and communicated face-to-face. Our results are consistent with those of prior efforts to quantify indirect patient care 5 and show that medical chart review accounted for most activity. Using electronic audits to analyze EHR use, we show that residents continue to spend more than a third of their time on indirect patient care. 4 However, today’s EHR systems commonly feature time-saving tools that have eliminated daily transcription of vital signs, laboratory values, and medications. Studies performed before EHRs suggest a long-standing imbalance between indirect and face-to-face patient care. P values for numerical and count data were calculated by 2-tailed t tests and Fisher exact tests, respectively, with significance thresholds of. Data processing was performed with Python software, version 2.7, and R, version 2.13. Because patient information is updated through EHR sign-out during transitions of care, total working time was calculated as the difference between the first and last action recorded each day. This study was reviewed and approved by the Stanford Administrative Panel on Human Subjects in Medical Research.Ĭonsecutive actions were considered part of a single computer session if they were separated by less than 5 minutes of inactivity. Bedside computers are reserved for nursing duties while physician workstations are located in separate workrooms. Data were extracted with our institutional informatics platform 3 and linked with residency scheduling information. These included, but were not limited to, reviewing medical charts, placing orders, accessing laboratory results, and generating notes. Actions corresponded to behaviors performed on the EHR, recording activities as clinicians move through various parts of the medical chart. In March 2015 we retrospectively analyzed all time-stamped electronic actions logged between Jand June 29, 2014, by internal medicine house staff at a large academic university hospital by institutional EHR audit. ![]() Our institution uses the EPIC EHR system. Shared Decision Making and Communication. ![]() ![]() Scientific Discovery and the Future of Medicine.Health Care Economics, Insurance, Payment.Clinical Implications of Basic Neuroscience.Challenges in Clinical Electrocardiography.
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