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    Study sheds light on in-room time with patients, EHR documentation

    With proper modeling, time stamps may help to schedule patients optimally, configure clinic


    Part 2: Big Data

    Dr. Chiang explained that when he headed up of the medical information technology committee of the American Academy of Ophthalmology, he heard many physician complaints, such as: “I’m spending all day and all night charting in the EHR—I never used to do that with paper.”

    To understand why that situation occurs, the group decided to do an EHR time-stamp analysis. EHR systems record every point and click of the mouse and log them, so researchers were able to determine which actions best corresponded with what the physician was actually doing during the patient visit.

    The next step was to use the data to figure out how much time was spent documenting in the EHR, and whether it was during the exam or afterward.

    Before doing that, the physicians wanted to validate the method of using the time-stamps, compared with the gold standard of manual time-motion collection using the iPad apps.

    The five physicians followed in the study generated 3 million time-stamps in 1 year in the EHR audit log. About 400 patients were looked at to compare manual observation with the iPad with the EHR time stamps. The difference between them was only about 1 minute, which the researchers considered very similar. 

    Results showed that the pediatric ophthalmologist spent 9.9 minutes documenting each patient.

    Of that, 46% of the time was during the patient visit; 41% of the time was during business hours after the visit, and 12% of the time was on nights and weekends. If 30 patients are seen in a day, that corresponds to nearly 5 hours per day documenting in the EHR. For the other four ophthalmologists, the distribution of time was similar.

    Time demands

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