Advertisement

4000 Clicks: a productivity analysis of electronic medical records in a community hospital ED

Published:September 23, 2013DOI:https://doi.org/10.1016/j.ajem.2013.06.028

      Abstract

      Objective

      We evaluate physician productivity using electronic medical records in a community hospital emergency department.

      Methods

      Physician time usage per hour was observed and tabulated in the categories of direct patient contact, data and order entry, interaction with colleagues, and review of test results and old records.

      Results

      The mean percentage of time spent on data entry was 43% (95% confidence interval, 39%-47%). The mean percentage of time spent in direct contact with patients was 28%. The pooled weighted average time allocations were 44% on data entry, 28% in direct patient care, 12% reviewing test results and records, 13% in discussion with colleagues, and 3% on other activities. Tabulation was made of the number of mouse clicks necessary for several common emergency department charting functions and for selected patient encounters. Total mouse clicks approach 4000 during a busy 10-hour shift.

      Conclusion

      Emergency department physicians spend significantly more time entering data into electronic medical records than on any other activity, including direct patient care. Improved efficiency in data entry would allow emergency physicians to devote more time to patient care, thus increasing hospital revenue.
      To read this article in full you will need to make a payment
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to The American Journal of Emergency Medicine
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Bukata R.
        Electronic health records—where's the beef?.
        EMA. 2011; 35 (Available at http://www.ccme.org/EMA/. Accessed October 9, 2012): 2
      1. Bukata R. When evaluating EMR efficacy, where's the beef? Emergency Physicians Monthly, November 2012; 18–19.

        • Yen S.
        • Shane E.
        • et al.
        Time motion study in a pediatric emergency department before and after computer physician order entry.
        Ann Emerg Med. 2009; 53: 462-467
        • Furukawa M.F.
        Electronic medical records and the efficiency of hospital emergency departments.
        Med Care Res Rev. 2011; 68: 75-95
        • Linder J.A.
        • et al.
        Electronic health record use and the quality of ambulatory care in the United States.
        Arch Intern Med. 2007; 167: 1400-1405
        • Romano M.J.
        • Stafford R.S.
        Electronic health records and clinical decision support systems: impact on national ambulatory care quality.
        Arch Intern Med. 2011; 171: 897-903
        • Jones S.S.
        • Adams J.L.
        • et al.
        Electronic health record adoption and quality improvement in US hospitals.
        Am J Manag Care. 2010; 16: 64-71
        • Barrueto Jr., F.
        • Pimentel L.
        Analyzing the impact of electronic charting on physician productivity and charge capture using statistical process control: a pilot study.
        Ann Emerg Med. 2012; 60: S14
        • Carr C.M.
        • et al.
        The impact of a health information exchange on the management of patients in an urban academic emergency department: an observational study and cost analysis.
        Ann Emerg Med. 2012; 60: S15
        • Ward M.U.
        • et al.
        The impact of electronic health record implementation on emergency department operations.
        Ann Emerg Med. 2012; 60: S25
        • Asaro P.
        • Boxerman S.
        Effects of computerized provider order entry and nursing documentation on workflow.
        Acad Emerg Med. 2008; 15: 908-915
        • Marill K.
        • Gauharou E.
        • et al.
        Prospective, randomized trial of template-assisted versus undirected written recording of physician records in the emergency department.
        Ann Emerg Med. 1999; 33: 500-509
        • Hollingsworth J.
        • Chisholm C.
        • et al.
        How do physicians and nurses spend their time in the emergency department?.
        Ann Emerg Med. 1998; 31: 87-91
        • Handel D.
        • et al.
        Implementing electronic health records in the emergency department.
        J Emerg Med. 2010; 38: 257-263
      2. JP Morgan Presentation 010713, 5.
        (Retrieved 5/13/13 from:)
        • Patel S.
        • Rais A.
        • Kumar A.
        Focus on: the use of scribes in the emergency department.
        (ACEP [ACEP Website] Available at) (Accessed November 25, 2012)
        • Cearnal L.
        Electronic medical records link to upcoding under fire.
        Ann Emerg Med. 2013; 61: 17A-19A
      3. Solving the EMR Conundrum. MD News Special Pennsylvania Edition. 2013:42–44.

      4. Bukata R. Less ‘art’, more evidence. Emergency Physicians Monthly. Dec. 2012; 32.

        • Sittig D.
        • Singh H.
        Legal, ethical and financial dilemmas in electronic health record adoption and use.
        Pediatrics. 2011; 127: 1042-1047
      5. Genes N, Baumlin K. Beware the data behind the data. Emergency Physicians Monthly, 2012.

        • Mangalmurti S.
        • Murtaugh L.
        • Mello M.
        Medical malpractice liability in the age of electronic health records.
        N Engl J Med. 2010; 363: 2060-2067
      6. Working Safely with Video Display Terminals. US Department of Labor, OSHA.
        (Available at:) (Accessed January 2, 2013)
        • Arya R.
        • Salovich D.M.
        • et al.
        Impact of scribes on performance indicators in the emergency department.
        Acad Emerg Med. 2010; 17: 490-495
        • Marshall J.S.
        • et al.
        Implementation of medical scribes in an academic emergency department: effect on emergency department throughput, clinical productivity, and emergency department physician professional fees.
        Ann Emerg Med. 2012; 60: S105