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Multitasking, silent EHR use affect patient care

Although most clinicians multitask while using electronic health records, which increases the risk for communication and timeliness errors, transitions to silent EHR use can have unclear ramifications, according to a research letter published in JAMA Internal Medicine.

“Electronic health record (EHR) implementation may affect time allocation during patient visits,” Neda Ratanawongsa, MD, MPH, from the division of general internal medicine at the University of California, San Francisco and the UCSF Center for Vulnerable Populations at San Francisco General Hospital, and colleagues wrote. “Clinicians may use EHRs in silence, risking lower patient satisfaction, or ... multitasking while talking with patients. Concurrent multitasking (performing > 2 tasks simultaneously) is associated with increased error risk and time to compete tasks.”

In this observational study conducted from 2013 to 2015, researchers assessed time allocation and transitions into and out of silent EHR use in five primary and specialty safety-net clinics after EHR implementation. They enrolled 25 clinicians and 25 English-speaking and/or Spanish-speaking adult patients, and recorded video of the visits 3 to 16 months after implementing the EHR. Patients were asked to rate their recent quality of care as poor to excellent after visits. The investigators separated visits into categories: multitasking EHR use (while clinician or patient spoke), silent EHR use (silence of 3 seconds or more), non-EHR multitasking, silent non-EHR tasks, education with EHR, education with paper; physical examination; and focused patient-clinician talk.

Analysis showed that multitasking time surpassed silent EHR use. Of 35 visits that occurred between 25 patients and 25 clinicians, multitasking EHR use comprised 30.5% of visit time, silent EHR use comprised 4.6%, multitasking non-EHR tasks comprised 4.3% and focused patient-clinician talk comprised 33.1%. Participants rated care as excellent after 66.7% of low-multitasking EHR use visits and 76.5% of high-multitasking EHR visits (P=.65). Out of 193 instances of silent EHR use, most occurred while clinicians viewed (39.4%) or entered (24.4%) information, but also occurred while they prescribed (13.5%), reconciled medications (8.3%), scheduled appointments (5.2%), ordered tests/referrals (5.2%) and input patient education (3.1%). The median silent EHR use was 16.2 seconds. Ratanawongsa and colleagues found that clinicians expressed many diverse transitions into silent EHR use, some signaling a need to focus, while others shifted into silence without warning. Frequently, patients broke the silence during EHR use with small talk or by asking about their health concerns.

“Clinicians must attend to emerging patient concerns and decide whether to address those concerns, defer them to complete EHR tasks safely, or attempt to complete both, despite multitasking risks,” Ratanawongsa and colleagues wrote. “Studies should explore strategies for negotiating multitasking and silent EHR use, engaging patients ‘actively’ during silent EHR use, and ensuring clinicians detect emerging patient concerns.” – by Savannah Demko

Disclosures: The researchers report no relevant financial disclosures.