- Providers in the emergency department (ED) who had more experience or training with an electronic health record (EHR) system completed EHR documentation faster than those with less experience, a study published in AHIMA’s Perspectives in Health Information Management revealed.
While the EHR is meant to improve quality, safety, and efficiency in clinical settings, past studies have shown that EHRs do not reduce physician data entry time, the researchers stated. The team noted that emergency medicine physicians report spending between 23 percent and 65 percent of their time on EHR documentation.
“Frustration with the lack of ease of use associated with EHR systems contributes to physician burnout and a perceived loss of professional autonomy,” the group said.
“Moreover, the time devoted to EHR systems is associated with physicians feeling disconnected from their patients and team and has led to an explosion in the use of scribes to assist with documentation over the past 10 years.”
The researchers set out to examine the time required to document video-recorded standardized patient encounters in two different EHR systems. The team wanted to evaluate the efficiency and accuracy of a novel EHR system, as well as study the relationship between training levels and documentation time.
Researchers evaluated the performance of residents from a three-year academic residency program as well as rotating fourth-year medical students (MS4).
Each participant was shown video recordings for three standardized patient encounters, and documented each encounter using two EHR user interfaces, Cerner and Sparrow. The Cerner system was the system currently in use at the hospital’s ED, while the Sparrow system was new to all participants.
The results showed that using the Cerner system, the average documentation time was 15.9 minutes for MS4 students, 13.6 minutes for first-year trainees, 11.2 minutes for second-year trainees, and 11.2 minutes for third-year trainees. Overall, participants spent an average of 12.7 minutes on documentation using the Cerner system.
Using the Sparrow system, the average documentation time was 16.2 minutes for MS4 students, 14.6 minutes for first-year trainees, 13.2 minutes for second-year trainees, and 14.0 minutes for third-year trainees.
On average, participants spent 14.3 minutes on documentation with the Sparrow system, which was slightly slower than on the Cerner system.
The team noted that although there were differences in documentation time between the two systems, the findings showed that users with more experience consistently documented patient encounters faster than those with less experience, indicating that level of training with a system has a significant impact on data recording time.
“Documentation on the Cerner system was faster for more experienced residents compared with less experienced users,” the researchers said.
“This experience benefit was not as dramatic for the Sparrow system, which was new to all users; however, those with more experience were still faster than those with less, suggesting that some efficiency in documentation may be associated with the ability to distinguish clinically relevant information from the entirety of a patient encounter.”
The results also showed that participants spent more time recording data into the EHR than they would have spent with the patient. Of the entire patient encounter time, the percentage of time spent documenting for each of the three patient encounters was 63 percent, 56 percent, and 62 percent when participants used the Cerner system.
When using the Sparrow system, the percentage of time spent documenting for the three patient encounters was 67 percent, 58 percent, and 66 percent across all participants.
“Even though the use of standardized patient care plans in this study meant that time spent in clinical decision making was removed, more time was spent on documentation than was spent with the patient,” the team wrote.
Previous studies have examined the effectiveness of scribes or alternative documentation tools, the researchers noted, and have shown that these methods can reduce EHR data recording time. The team said that going forward, research could focus on comparing traditional documentation with newer approaches.
“Future studies could compare keyboard versus voice dictation for documentation time, and could offer a comparison of documenting during a patient encounter and documenting after the encounter in another location, to determine which option offers better efficiency overall,” the group stated.
The study’s findings reveal that a provider’s training level and knowledge of an EHR system can significantly affect the amount of time it takes to document a patient encounter. Reducing clinical documentation time in the ED and other health system departments will require thorough training.
“This study demonstrated that the level of training and experience with a system affected the time of documentation,” the researchers concluded.
“Technical innovations and evaluation of the user experience and patient experience should be incorporated into the training of emergency medicine residents.”