- Patient context integration of a picture archiving and communications system (PACS) with an organization’s EHR can lower EHR access time for radiologists, according to a study published in the Journal of Digital Imaging.
PACS integration significantly reduced the time it took radiologists to access clinical data in the EHR, which in turn increased EHR utilization, determined Mongan, et al. Following PACS integration, the EHR access time lowered from 52 seconds to six seconds.
“Although the average of 46 s saved per EMR access may at first glance seem like a relatively trivial period of time, short delays for frequent tasks become large in aggregate,” researchers explained. “For instance, based on the number of EMR accesses in the pre-integration period, the time saved by this 46-s reduction amounts to an average of more than a working day (8.26 h) per radiologist per year.”
The efficiency increase shows how important a PACS-EMR integration can be, the research team stressed.
For the study, researchers measured the time to access a clinic note in the EMR before and after integration with a stopwatch. Data was collected from February 5, 2014 to April 1, 2015. EMR-PACS integration was accomplished using file-based communication between the PACS client and the EMR client on the PACS workstation.
“EMR usage data were obtained from security audit logs,” researchers wrote. “These data included the radiologist accessing the record, time stamp, patient medical record number (MRN), and portion of the record accessed. In the post-integration period, the EMR automatically presented a summary report (including items such as vitals, relevant recent labs, and lines and tubes) for each patient viewed in PACS.”
The research team gathered EHR access data on 37 users spanning a period from 180 days prior to the implementation of integration to 240 days after. In total, 51,926 studies were interpreted.
The total proportion of studies with EHR access increased from 36.7 percent prior to integration to 44.9 percent afterward.
Increases in EHR usage could not be explained by increasing residents’ training level with the passage of time, the report stated. Specifically, the proportion of studies for which the EHR was accessed was similar across the three residency classes from most junior to most senior, at 43.2 percent, 41.2 percent, and 43.1 percent, respectively.
“The 8.2 percentage point increase in proportion of studies for which the EMR was consulted represents a 22% increase in the likelihood that a radiologist would seek additional clinical data for a given study,” researchers stated. “The increase in EMR usage accounted for the 37 radiologists obtaining additional clinical data on approximately 2500 additional cases during the 180-day post-integration period that they otherwise would not have, based on pre-integration EMR usage proportions.”
There was also a noted behavioral change with the PACS integration, which increased as time passed. There was a 9.4 percentage point increase over the 180-day post-integration sample period with about half of the studies on EHR access.
“This may be because the experience of efficiently accessing useful information in the EMR creates a positive feedback loop that makes radiologists more likely to access the EMR in future cases,” the research team maintained.
However, it could not be determined whether a radiologist “viewed or obtained additional clinical data from the automatically opened summary report in the post-integration period.” It was likely that there were indeed some cases where this occurred, which means that the integration’s true effect may be underestimated.
“Although this leaves open the possibility that other factors besides the implementation of integration affected EMR usage, there were no other significant changes to the clinical systems used by radiologists during this period, and the timing of the change in proportion of EMR usage was well correlated with the timing of the integration,” the researchers explained.
“Medical centers with faster login and access times for non-integrated EMRs might see less benefit to integration than was realized in this study,” the authors continued. “Additionally, the EMR access patterns of academic radiologists and trainees may not be representative of private practice radiologists, who read the majority of radiology studies in America.”
Overall, it is still reasonable to expect a PACS integration to lead to increased EHR usage, the team concluded. The time saved from such an approach could “drive changes in radiologist practice projected to change diagnosis in 1 out of every 200 cases read.”
“PACS-EMR patient context integration should be considered an essential component of every PACS environment,” the team stated.
It has been previously noted how cutting down on EHR usage time could benefit healthcare organizations.
Research published in AHIMA’s Perspectives in Health Information Management in April 2018 found that Lean methodologies could reduce EHR use improve clinical documentation.
The research team determined that redesigning inefficient, first-generation EHR systems can aid clinical documentation, boost provider satisfaction, and cut provider EHR use by almost one hour per day.
“Analysis of data showed that the project met or nearly met the goals set initially and within the time frame of 60 days after implementation,” the team wrote. “The goal of decreasing the therapists’ time in the EHR was expected to lead to the possibility of therapists having more time available for direct patient care.”
Lean methodology also helped therapists cut the average amount of time spent on EHR use from 2.8 hours per day to 1.9 hours, while therapists also increased the amount of time they spent interacting with patients face-to-face by 18 percent.
“This implementation of Lean methodology applied by Mayo Clinic Rehabilitation Services proved to be an effective approach to identify inefficiencies in the first-generation EHR documentation templates and processes,” researchers maintained.