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Ophthalmologists Spend 27 Percent of Patient Visits on EHR Use

Findings suggest ophthalmologists spend a substantial portion of brief patient encounters on EHR use.


Source: Thinkstock

By Kate Monica

- A new study published in the Journal of the American Medical Association (JAMA) Ophthalmology found ophthalmologists spend 27 percent of a typical patient encounter on EHR use, suggesting a need for EHR usability improvements.

The study by Read-Brown et al. aimed to gauge how much time physicians spent during patient encounters on EHR use, patient conversation, and patient examination. Additionally, researchers measured how much time ophthalmologists spent on EHR use throughout a typical workday.

Researchers at the Oregon Health & Science University in Portland studied 27 ophthalmologists between September 1, 2013 and December 31, 2016 in a total of 46,519 patient encounters. During the study, researchers observed time stamps from the medical record and EHR audit log to analyze the length of time each ophthalmologist was required to spend using EHR technology. Additionally, physicians participated in manual time-motion observation to demonstrate how much time was used for each activity.

The study showed ophthalmologists spent approximately 11 minutes on each patient examination. About three minutes (27 percent) of each examination were generally dedicated to direct EHR use, while four and a half minutes (42 percent) were spent on patient conversation.

Furthermore, ophthalmologists typically spent about three and a half hours on EHR use during a full day at work in the clinic. A little over two hours of this EHR use generally occurred during patient encounters, while about an hour and a half of this time was spent outside the clinic session.

Additionally, researchers found a positive association between EHR use and billing level and a negative association between EHR use per encounter and clinic volume.

Ultimately, researchers determined EHR use demands too much of an ophthalmologist’s time.

“The key findings from the manual time-motion observation and data analysis of EHR time stamps were that ophthalmologists have limited time with patients, time requirements associated with EHR use are significant, and ophthalmologists differ in their patterns of EHR use,” wrote researchers.

First, researchers noted the potentially negative effects of the limited amount of time ophthalmologists were shown to spend with each patient.

“During patient visits, physicians are expected to address acute and chronic issues, provide preventive care, and form a relationship with the patient,” researchers stated. “These time pressures may have negative consequences for patients, as research suggests that physician performance suffers under time pressure.”

Researchers suggested the use of EHR technology by physicians during patient visits could worsen the negative effects of limited patient encounters. Additionally, researchers expressed the study confirms previous findings that EHR use presents a significant burden on physicians.

“Overall, these quantitative study findings support physicians’ reports of using EHRs during and after work hours for excessive lengths of time,” they maintained.

Researchers recommended EHR developers and health IT companies focus on developing technology better suited to the needs of patients and physicians.

“In summary, these findings highlight the importance of developing EHRs to meet the needs of patients and physicians and to develop appropriate training programs to improve the quality and efficiency of care,” researchers wrote.

They suggested EHR usability improvements and patient-centered design methods in particular could assist in improving EHR workflow and data accessibility moving forward.

“Professional groups have long advocated for improved EHRs designed in collaboration between clinicians and vendors, yet the efficiency of current EHRs continues to be a challenge,” they stated. “We hope that this study will inspire clinicians and system designers to collaborate on improving EHR systems.”

This research backs the findings of a previous study by the University of Wisconsin and the American Medical Association (AMA) that found primary care physicians spend almost 6 hours on EHR data entry during a typical 11.4 hour workday.

Following the study, AMA issued a guide to assist health IT developers in devising EHR usability improvements to boost provider satisfaction. 



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