This article is more than 5 years old. Information may no longer be current.

EHR use accounts for one-third of working time of residents

An institutional audit of the electronic health record system used by internal medicine house staff found that residents spent more than 30% of their time using the system, according to data published in JAMA Internal Medicine.

David Ouyang, MD, in the department of internal medicine at Stanford University School of Medicine, and colleagues reported that the majority of time was spent reviewing medical charts.

"In addition to direct patient contact, residents are responsible for communication, order entry, data review and documentation," Ouyang and colleagues wrote. "With more patient care being facilitated through computers today, there is increasing concern that little time remains for direct patient contact and education."

The researchers analyzed the EPIC EHR system, retrospectively evaluating time-stamped actions entered between June 25, 2013 and June 29, 2014 and linking them to residency scheduling information. Data included 4,327,708 unique actions that had been performed by 91 residents.

Results demonstrated that peak EHR activity occurred in the morning and decreases occurred during teaching conference times.

House staff worked a median 69.2 hours each week, with a median 4.2 hours of time spent using the EHR system each day. They reviewed a median 14 medical charts and logged a median of 31 independent EHR sessions each day.

Ouyang and colleagues found that medical chart review accounted for more than 40% of EHR activity.

"Studies performed before EHRs suggest a long-standing imbalance between indirect and face-to-face patient care," Ouyang and colleagues wrote. "However, today’s EHR systems commonly feature time-saving tools that have eliminated daily transcription of vital signs, laboratory values and medications. 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. Our results are consistent with those of prior efforts to quantify indirect patient care and show that medical chart review accounted for most activity."

The researchers concluded that it is essential for programs to understand how EHRs affect responsibilities and education as the role of EHRs increases. – by Chelsea Frajerman Pardes

Disclosures: The authors report no relevant financial disclosures.