4,000 Clicks Per Shift: ED Physicians' EMR Burden

Emergency department physicians spent 44 percent of their time entering data into electronic medical records, clicking up to 4,000 times during a 10-hour shift, according to results from a study recently published in the American Journal of Emergency Medicine.

EMRs can provide significant benefits in terms of patient safety, improved communication and more efficient administrative procedures. However, the EMR system deployed hospitalwide is often not optimized for the unique workflow of the ED.

Following Duncan (Okla.) Regional Hospital's implementation of an EMR system earlier this year, ED Medical Director Travis Brown, DO, noticed struggles in his department. "There's definitely been an impact on efficiency," he says. "When EMRs are adding five to 10 minutes per patient, and when you're seeing three to four patients per hour in the ED — the impact on flow just isn't sustainable."

To investigate the issue, researchers analyzed ED physicians' workflow at the ED on the Allentown, Pa., campus of St. Luke's University Health Network. Attending physicians, residents and other providers were followed for 30 hours to determine the percentage of time spent on direct patient contact, data entry and order entry, consultation and discussion with other staff members and record and test result review. The numbers of mouse clicks and patients per hour for the 16 participating physicians were also calculated.

Averaged results showed the physicians spent about 44 percent of their time in front of an EMR entering patient data or orders, 28 percent of their time with patients, 12 percent of their time reviewing charts and testing results and 13 percent of their time in discussion with colleagues.

Researchers also found the number of mouse clicks increased as the physicians' per-hour patient load increased. Two patients per hour resulted in about 320 clicks per hour, 2.12 patients per hour resulted in 339 clicks per hour and 2.5 patients per hour meant, on average, physicians clicked about 400 times per hour.

"We were not surprised with the results," says Lynn Hill, MBA, one of the study's authors. The findings of this study are consistent with the findings of others, showing traditional paper-based documentation to have always consumed about a third of a physicians' workday, and electronic charts taking about a third longer than paper charts to complete[1].

To help mitigate the negative effects on ED physicians' workflows, Ms. Hill recommends considering these concerns, and the concerns of all stakeholders, before making an EMR purchase. "[Put] together a cross-functional team comprised of finance, administration, medical records staff, nursing, doctors and IT professionals and anyone that has a stake in the productivity and functionality of the system," she says. "The team will evaluate software in terms of the various departments' requirements and as well as the needs of hospital management" and provide valuable insight on selecting the best system.

For organizations with an EMR already in place, Ms. Hill recommends reaching out to other hospitals that use the same system to share best practices for overcoming workflow and other issues. Interviews with other hospitals' staff members may bring to light innovative solutions for overcoming shared problems. "Hospitals can then implement new procedures to realize greater efficiency," she says, citing medical scribes as a workaround that has been beneficial for some hospitals.

"There may be other creative solutions as well — we hope the article sparks constructive dialog and learning in the industry," she says.

More Articles on EMRs:

How to Combat EMR Copy and Paste Errors
How Massachusetts General Successfully Incentivizes Physicians to Use EMRs
Do EMRs Turn Doctor Visits Into Impersonal Interactions?



Patel S, Rais A, Kumar A. Focus on: the use of scribes in the emergency department.

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