by Paul Govern
According to a new large-scale descriptive study in the journal Pediatrics, for each outpatient encounter, pediatricians on average spend 16 minutes using the electronic health record (EHR).
That includes work in the EHR on the day of the patient’s visit and any work the pediatrician may do in the days following the visit, before officially closing out the encounter.
“Our study draws on a wealth of data to add to our understanding of EHR usage and the documentation burden for today’s clinicians,” said Kevin Johnson, MD, MS, professor and chair of Biomedical Informatics, professor of Pediatrics and informatician in chief at Vanderbilt University Medical Center, one of two co-authors of the study. “We were able to break out various EHR tasks, shedding light on where opportunities may lie to improve these systems and their associated workflows.”
The study uses data from some 20 million patient encounters involving 30,000 pediatricians, or 44% of the nation’s total. Johnson collaborated on the study with the former chief medical informatics officer at leading EHR software vendor Cerner Corp., Marc Overhage, MD, PhD (Overhage is currently with the Alliance for Cell Therapy Research). The study examines Cerner EHR log files from some 417 U.S. health systems for all of 2018.
By placing time limits around computer keystrokes and mouse clicks/movements, the investigators were able to distinguish work in the EHR from times when records may have sat idly open while the clinician-user turned momentarily to other tasks.
The authors were able to break clinician work in the EHR into 13 categories; chart review accounted for the most time, followed by documentation and then ordering — these three together accounting for 75% of pediatrician activity in the EHR.
While the average time per encounter was 16 minutes for pediatricians as a whole, the average varied across pediatric subspecialties: pediatric surgery 6.82 minutes; cardiology 12.41; critical care 13.01; general pediatrics 13.53; pulmonology 17.16; hematology-oncology 17.18; gastroenterology 17.52; nephrology 17.74; endocrinology 19.72; infectious diseases 20.82; rheumatology 26.41.
“With everyone in this study using Cerner’s software, the wide variation that we found within each subspecialty is perhaps surprising and suggests significant opportunity for more efficient use of the EHR as presently configured,” Johnson said.
“While it’s generally acknowledged that the EHR can support improved health care quality and safety, there’s widespread concern that documentation requirements, and perhaps the sometimes unwieldy configuration of the EHR itself, are needlessly sapping time from clinicians, time that could be better spent engaging patients and family members.”
A previous descriptive study using Cerner EHR log files found that physicians serving adult patients spent an average 16 minutes and 14 seconds per patient encounter working in the EHR.
“We think usage data of this sort provide an important set of metrics against which we can compare new EHR innovations,” Johnson said.