Study quantifies significant time spent documenting in EHRs

Issue: May 10, 2016

VANCOUVER, British Columbia — Like in other ophthalmic specialties, a significant amount of the pediatric ophthalmologist’s time is spent documenting in electronic health records, perhaps detrimentally so, according to a study presented here.

“There’s been a lot of anecdotal and some published evidence showing that there may be a negative impact of EHRs on efficiency by ophthalmologists,” Michael F. Chiang, MD, said at the American Association for Pediatric Ophthalmology and Strabismus meeting.

Michael F. Chiang

With that notion, Chiang and colleagues at Oregon Health and Science University undertook a two-part study to determine how ophthalmologists spend time in-room with patients and how much time is required for documenting in the EHR.

Using trained observers with iPads to document five ophthalmologists’ time examining, documenting or talking to patients, Chiang and colleagues found the pediatric ophthalmologist spent on average 13 minutes with the patient. Of that 13 minutes, 27% of the time was spent documenting in the EHR, 45% of the time was spent examining and 29% was spent talking. In general, this pattern of almost 30% of in-room time spent documenting was similar among the other four ophthalmic subspecialties observed: general, cornea, glaucoma and retina.

Regarding total documentation time, Chiang and colleagues used an EHR timestamp analysis that tracked mouse clicks to map workflow and identify timing of key events. They found that the pediatric ophthalmologist, who saw 2,500 patients over 1 year, spent 10 minutes of documentation time per patient. Of that 10 minutes, 46% of the documentation time occurred during the visit when the patient was in the office, 41% occurred during business hours after the patient had left the office, and 12% occurred on nights and weekends, Chiang said.

“How much is 10 minutes per patient? If you saw 30 patients per day, then it’s 5 hours per day pointing and clicking at the EHR,” Chiang said.

The impact on patient care is unclear, but there is a need for improved EHR design, he said. – by Patricia Nale, ELS

Reference: Chiang MF. Time requirements for pediatric ophthalmology documentation with electronic health records (EHRs): A time-motion and big data study. Paper 6 presented at: American Association for Pediatric Ophthalmology and Strabismus 42nd annual meeting; April 6-10, 2016; Vancouver, British Columbia.

Disclosure: Chiang reports no relevant financial disclosures.