Promoting Quality Face-to-Face Communication during Ophthalmology Encounters in the Electronic Health Record Era

Sally L. Baxter; Helena E. Gali; Michael F. Chiang; Michelle R. Hribar; Lucila Ohno-Machado; Robert El-Kareh; Abigail E. Huang; Heather E. Chen; Andrew S. Camp; Don O. Kikkawa; Bobby S. Korn; Jeffrey E. Lee; Christopher A. Longhurst; Marlene Millen

doi:10.1055/s-0040-1701255

Applied Clinical Informatics, Inhaltsverzeichnis

Appl Clin Inform 2020; 11(01): 130-141
DOI: 10.1055/s-0040-1701255

Research Article

Georg Thieme Verlag KG Stuttgart · New York

Promoting Quality Face-to-Face Communication during Ophthalmology Encounters in the Electronic Health Record Era

Authors

Sally L. Baxter

¹Shiley Eye Institute and Viterbi Family Department of Ophthalmology, University of California San Diego, La Jolla, California, United States

²Health Sciences Department of Biomedical Informatics, University of California San Diego, La Jolla, California, United States
Helena E. Gali

¹Shiley Eye Institute and Viterbi Family Department of Ophthalmology, University of California San Diego, La Jolla, California, United States

²Health Sciences Department of Biomedical Informatics, University of California San Diego, La Jolla, California, United States
Michael F. Chiang

³Department of Medical Informatics and Clinical Epidemiology, Oregon Health and Science University, Portland, Oregon, United States

⁴Department of Ophthalmology, Casey Eye Institute, Oregon Health and Science University, Portland, Oregon, United States
Michelle R. Hribar

³Department of Medical Informatics and Clinical Epidemiology, Oregon Health and Science University, Portland, Oregon, United States

⁴Department of Ophthalmology, Casey Eye Institute, Oregon Health and Science University, Portland, Oregon, United States
Lucila Ohno-Machado

²Health Sciences Department of Biomedical Informatics, University of California San Diego, La Jolla, California, United States

⁵Division of Health Services Research and Development, Veterans Administration San Diego Healthcare System, San Diego, California, United States
Robert El-Kareh

²Health Sciences Department of Biomedical Informatics, University of California San Diego, La Jolla, California, United States
Abigail E. Huang

³Department of Medical Informatics and Clinical Epidemiology, Oregon Health and Science University, Portland, Oregon, United States
Heather E. Chen

¹Shiley Eye Institute and Viterbi Family Department of Ophthalmology, University of California San Diego, La Jolla, California, United States
Andrew S. Camp

¹Shiley Eye Institute and Viterbi Family Department of Ophthalmology, University of California San Diego, La Jolla, California, United States
Don O. Kikkawa

¹Shiley Eye Institute and Viterbi Family Department of Ophthalmology, University of California San Diego, La Jolla, California, United States
Bobby S. Korn

¹Shiley Eye Institute and Viterbi Family Department of Ophthalmology, University of California San Diego, La Jolla, California, United States
Jeffrey E. Lee

¹Shiley Eye Institute and Viterbi Family Department of Ophthalmology, University of California San Diego, La Jolla, California, United States
Christopher A. Longhurst

²Health Sciences Department of Biomedical Informatics, University of California San Diego, La Jolla, California, United States
Marlene Millen

²Health Sciences Department of Biomedical Informatics, University of California San Diego, La Jolla, California, United States

Abstract

Objective To evaluate informatics-enabled quality improvement (QI) strategies for promoting time spent on face-to-face communication between ophthalmologists and patients.

Methods This prospective study involved deploying QI strategies during implementation of an enterprise-wide vendor electronic health record (EHR) in an outpatient academic ophthalmology department. Strategies included developing single sign-on capabilities, activating mobile- and tablet-based applications, EHR personalization training, creating novel workflows for team-based orders, and promoting problem-based charting to reduce documentation burden. Timing data were collected during 648 outpatient encounters. Outcomes included total time spent by the attending ophthalmologist on the patient, time spent on documentation, time spent on examination, and time spent talking with the patient. Metrics related to documentation efficiency, use of personalization features, use of team-based orders, and note length were also measured from the EHR efficiency portal and compared with averages for ophthalmologists nationwide using the same EHR.

Results Time spent on exclusive face-to-face communication with patients initially decreased with EHR implementation (2.9 to 2.3 minutes, p = 0.005) but returned to the paper baseline by 6 months (2.8 minutes, p = 0.99). Observed participants outperformed national averages of ophthalmologists using the same vendor system on documentation time per appointment, number of customized note templates, number of customized order lists, utilization of team-based orders, note length, and time spent after-hours on EHR use.

Conclusion Informatics-enabled QI interventions can promote patient-centeredness and face-to-face communication in high-volume outpatient ophthalmology encounters. By employing an array of interventions, time spent exclusively talking with the patient returned to levels equivalent to paper charts by 6 months after EHR implementation. This was achieved without requiring EHR redesign, use of scribes, or excessive after-hours work. Documentation efficiency can be achieved using interventions promoting personalization and team-based workflows. Given their efficacy in preserving face-to-face physician–patient interactions, these strategies may help alleviate risk of physician burnout.

Keywords

electronic health records - ophthalmology - quality improvement - informatics - communication

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