Abstract
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.
Keywords
physician performance - EHR logfiles - meaningful use - emergency department
