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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


    Time demands

    Overall, researchers concluded that there are significant time requirements for EHR documentation and that pediatric ophthalmology seems similar to other ophthalmic subspecialties. The impact on patient care, however, remains uncertain.

    EHR provides for better communication among different specialists, but may be creating a situation where physicians have less direct patient contact, due to time spent pointing and clicking in the system.

    “We need to improve EHR design, to fix this problem,” Dr. Chiang said. “There may be a role for the American Association for Pediatric Ophthalmology and Strabismus in developing standards.” 

    The ability to collect data from EHRs also has a silver lining, he noted.

    “Because we’ve got data about how long everything takes, we can use it for analytics,” he said.

    With proper modeling, Dr. Chiang believes they can use the time stamps to determine how to schedule patients optimally and configure the clinic.

    There are many issues to consider in improving efficiency of EHR systems. As physicians become more proficient with the system, the amount of time needed decreases.

    Scribes can be considered as an alternative to physicians performing data entry. Dr. Chiang’s group used that approach in the past, and then stopped using scribes when physicians and staff became faster with using the system. 

    In addition, at academic centers such as at OHSU, residents and fellows assist attending physicians in this area to improve the amount of time spent face to face with patients.

    Speech recognition software is another option to consider.

    Finally, the type of system used (for example an ophthalmology-specific system versus a more general system) can make a difference, as can the data-entry abilities of each user. 



    1. Verdon DR. Physician outcry on EHR functionality, cost will shake the health information technology sector. Medical Economics. February 2014. http://medicaleconomics.modernmedicine.com/medical-economics/content/tags/ehr/physician-outcry-ehr-functionality-cost-will-shake-health-informa?page=full.

    2. Chiang MF, Read-Brown S, Tu DC, et al. Evaluation of electronic health record implementation in ophthalmology at an academic medical center (an American Ophthalmological Society thesis). Evaluation of electronic health record implementation in ophthalmology at an academic medical center (an American Ophthalmological Society thesis). Trans Am Ophthalmol Soc. 2013;111:70-92.


    Michael F. Chiang, MD

    E: [email protected]


    This article was adapted from Dr. Chiang’s presentation at the 2016 meeting of the American Academy of Ophthalmology. He did not indicate any proprietary interest in the subject matter.


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