Electronic Health Records

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Are Medical Residents Spending Too Much Time on EHR Use?

Time spent on EHR use is noticeably increasing, and research shows that it may be to the detriment of patient care.

By Sara Heath

Internal medicine interns spend between five and seven hours per day on EHR use when caring for about 10 patients, research shows.

physician ehr use

In a study led by Lu Chen, MS, researchers looked at the large amount of time medical students spent navigating an EHR, hypothesizing that interns spend a very significant amount of time during their day on the technology.

In recent years, research has indicated such. In subjective studies of EHR use, researchers have found that EHRs may be more navigable, but providers are still spending more time using them.

“The amount of time spent on clinical documentation has been increasing since the late 1980s,” Chen and the team explained. “While electronic records are easier to read, significantly more time is spent on the EHR compared with paper charts. Recent studies have found that physicians spend more time on electronic documentation than providing direct patient care, and other studies have reported that clinical computer work constitutes the highest proportion of time spent by physicians.”

Chen and the research team sought to perform a quantitative study that would provide exact measurements for how long internal medicine students  spend using this technology.

The study employed “a built-in time tracking program from our EHR, and then to compare this to objectively reported times published in the literature,” Chen and the team explained.

The researchers tracked the amount of time each intern spent actively using their EHR by eliminating passive use, or use that was limited in mouse clicks, keystrokes, or mouse movement. They tracked the user group across May, July, and October 2014, and January 2015.

At the start of the study, the average amount of active EHR use time was around 40 minutes per patient, and come January that time improved to about 30 minutes per patient.

This totaled to about five hours per day spent on the EHR across 10 patient encounters, and improved as time went on.

“Our study objectively measured interns’ EHR use and found that interns spent at least 5 hours a day on the EHR caring for a maximum of 10 patients, confirming prior subjective reports,” the researchers reported. “Interns spent 7 hours a day in July and 5 hours of day in January.”

Chen and the team stated that increased experience and comfort with using EHRs may explain this improvement, claiming that as interns use the technology more they will become more proficient at it.

“This improvement was most likely gained from increased familiarity with using the EHR, comfort with managing different clinical scenarios, and learning from colleagues,” the researchers said.

This appears to be a trend across multiple studies. In a recent paper published by JMIR Human Factor, researchers indicated that as novice EHR users gain more experience with technology, they get qualitatively better at using it.

Overall, this study identified varying degrees of learnability gaps between expert and novice physician groups that may impede the use of EHRs,” the research team said. “The physicians’ interactions with the EHR can be communicated to EHR vendors, to assist in improving the user interface for effective use by physicians. This study may also assist in the design of EHR education and training programs by highlighting the areas… of difficulty that resident physicians face.”

Although there is a clear learning curve associated with EHR use, Chen and the research team suggested that there is still a problem with how novice users interact with EHR technology. Although providers are able to get better at using these programs, Chen claimed, they are still spending a lot of time navigating them when they could be delivering care directly to the patient.

“Although increased familiarity reduced time spent on clinical documentation, a significant portion of an intern’s day is still consumed by clinical computer work,” the team noted. “Therefore, to address resident satisfaction and thus improve motivation to provide patient-centered quality care, reducing the time residents spend on clinical documentation should be a priority.”



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