Time Spent on Dedicated Patient Care and Documentation Tasks Before and After the Introduction of a Structured and Standardized Electronic Health Record
Time Spent on Dedicated Patient Care and Documentation Tasks Before and After the Introduction of a Structured and Standardized Electronic Health Record
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DOI：
10.1055/s-0037-1615747
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发表时间：
2018-01-01
影响因子：
2.9
通讯作者：
de Keizer, Nicolette F.
中科院分区：
文献类型：
--
作者：
Joukes, Erik;Abu-Hanna, Ameen;de Keizer, Nicolette F.
背景 医生花费大约 35% 的时间记录患者数据。他们担心采用结构化和标准化的电子健康记录 (EHR) 将导致更多的记录时间和更少的患者护理时间，尤其是在咨询期间。 目的 本研究衡量引入结构化和标准化的 EHR 对记录时间和门诊咨询期间专门患者护理时间的影响。 方法 我们测量了医生在门诊咨询期间花在四个任务类别上的时间：记录、患者护理、同伴沟通和其他活动。医生涵盖了两所大学医院的各个专业，共同实施了结构化和标准化的电子病历。实施前，一家医院使用传统电子病历，另一家医院主要使用纸质记录。实施前2至6个月和实施后6至8个月由相同的医生进行观察。我们分析了咨询持续时间以及每个任务类别所花费的时间百分比。使用多级线性回归测试实施前后时间分布的差异。结果我们观察了 24 名医生（162 小时，439 次咨询）。我们发现咨询持续时间或每小时咨询次数没有显着差异。在传统 EHR 中心，我们发现实施与专门患者护理时间的显着减少相关 (-8.5%)。相比之下，在以前的纸质中心，我们发现用于记录的专用时间显着增加（8.3％），而患者护理和记录相结合的时间减少（-4.6％）。各中心对专用文档时间的影响存在显着差异。 结论 实施结构化和标准化 EHR 与一个中心会诊期间专用患者护理时间减少 8.5% 相关，而另一中心则使专用文档时间增加 8.3% 相关。这些结果符合医生的担忧，即引入结构化和标准化的电子病历可能会导致更多的文件负担和更少的专门患者护理时间。
Background Physicians spend around 35% of their time documenting patient data. They are concerned that adopting a structured and standardized electronic health record (EHR) will lead to more time documenting and less time for patient care, especially during consultations.Objective This study measures the effect of the introduction of a structured and standardized EHR on documentation time and time for dedicated patient care during outpatient consultations.Methods We measured physicians' time spent on four task categories during outpatient consultations: documentation, patient care, peer communication, and other activities. Physicians covered various specialties from two university hospitals that jointly implemented a structured and standardized EHR. Preimplementation, one hospital used a legacy-EHR, and one primarily paper-based records. The same physicians were observed 2 to 6 months before and 6 to 8 months after implementation. We analyzed consultation duration, and percentage of time spent on each task category. Differences in time distribution before and after implementation were tested using multilevel linear regression.Results We observed 24 physicians (162 hours, 439 consultations). We found no significant difference in consultation duration or number of consultations per hour. In the legacy-EHR center, we found the implementation associated with a significant decrease in time spent on dedicated patient care (-8.5%). In contrast, in the previously paper-based center, we found a significant increase in dedicated time spent on documentation (8.3%) and decrease in time on combined patient care and documentation (-4.6%). The effect on dedicated documentation time significantly differed between centers.Conclusion Implementation of a structured and standardized EHR was associated with 8.5% decrease in time for dedicated patient care during consultations in one center and 8.3% increase in dedicated documentation time in another center. These results are in line with physicians' concerns that the introduction of a structured and standardized EHR might lead to more documentation burden and less time for dedicated patient care.