Appl Clin Inform 2018; 09(01): 099-104
DOI: 10.1055/s-0037-1621705
Research Article
Schattauer GmbH Stuttgart

Efficiency of Emergency Physicians: Insights from an Observational Study using EHR Log Files

Thomas G. Kannampallil
Courtney A. Denton
Jason S. Shapiro
Vimla L. Patel
Funding This research is supported by grant #R01HS022670 from the Agency for Healthcare Research and Quality (AHRQ). The content is sole responsibility of the authors and does not necessarily represent the official views of the AHRQ.
Further Information

Publication History

26 July 2017

12 December 2017

Publication Date:
07 February 2018 (online)


Objective With federal mandates and incentives since the turn of this decade, electronic health records (EHR) have been widely adopted and used for clinical care. Over the last several years, we have seen both positive and negative perspectives on its use. Using an analysis of log files of EHR use, we investigated the nature of EHR use and their effect on an emergency department's (ED) throughput and efficiency.

Methods EHR logs of time spent by attending physicians on EHR-based activities over a 6-week period (n = 2,304 patients) were collected. For each patient encounter, physician activities in the EHR were categorized into four activities: documentation, review, orders, and navigation. Four ED-based performance metrics were also captured: door-to-provider time, door-to-doctor time, door-to-disposition time, and length of stay (LOS). Association between the four EHR-based activities and corresponding ED performance metrics were evaluated.

Results We found positive correlations between physician review of patient charts, and door-to-disposition time (r = 0.43, p < 0.05), and with LOS (r = 0.48, p < 0.05). There were no statistically significant associations between any of the other performance metrics and EHR activities.

Conclusion The results highlight that longer time spent on reviewing information on the EHR is potentially associated with decreased ED throughput efficiency. Balancing these competing goals is often a challenge of physicians, and its implications for patient safety is discussed.