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

2020 ◽  
Vol 11 (01) ◽  
pp. 130-141
Author(s):  
Sally L. Baxter ◽  
Helena E. Gali ◽  
Michael F. Chiang ◽  
Michelle R. Hribar ◽  
Lucila Ohno-Machado ◽  
...  
Keyword(s):  
Electronic Health Record ◽  
High Volume ◽  
Health Record ◽  
Patient Centeredness ◽  
Face To Face ◽  
Single Sign On ◽  
Timing Data ◽  
After Hours ◽  
Electronic Health ◽  
Physician Patient

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.

scholarly journals 29 Predicting Unplanned Readmission and Death After Hospital Discharge: How Do Frailty Tools Compare to Electronic Health Record Frailty Markers?

2021 ◽  
Vol 50 (Supplement_1) ◽  
pp. i7-i11
Author(s):  
A Anand ◽  
Y Yong Tew ◽  
J Hao Chan ◽  
P Keeling ◽  
S D Shenkin ◽  
...  
Keyword(s):  
Electronic Health Record ◽  
Hospital Discharge ◽  
Royal Infirmary ◽  
Unplanned Readmission ◽  
Health Record ◽  
Clinical Frailty Scale ◽  
Standard Deviation Increase ◽  
Face To Face ◽  
Hospitalised Patients ◽  
Electronic Health

Abstract Introduction Numerous frailty tools and definitions have been described. Amongst hospitalised patients, the validity of face-to-face instruments may be confounded by acute illness. However, patient assessment after recovery at the point of hospital discharge, or recognition of electronic health record (EHR) frailty markers, may overcome this issuep. Methods In a consented, prospective observational cohort study, we recruited patients ≥70 years old within 24 hours of expected discharge from the cardiology ward of the Royal Infirmary of Edinburgh. Three established frailty instruments were tested: the Fried phenotype, Short Physical Performance Battery and nurse-administered Clinical Frailty Scale (CFS). An unweighted 32-item EHR score was generated using frailty markers (e.g. falls risk, continence, cognition) recorded within mandated admission documentation. Comorbidity was assessed by count of chronic health conditions. Outcomes were a 90-day composite of unplanned readmission or death and 12-month mortality. Adjusted Cox modelling determined the hazard ratio (HR) per standard deviation increase in each frailty score. Results 186 patients (mean age 79 ± 6 years, 64% male) were included, of whom 55 (30%) had a 90-day composite outcome, and 21 (11%) died within 12 months. All four frailty tools were moderately correlated with age and comorbidity (Pearson’s r 0.21 to 0.43, all p < 0.05). The Fried phenotype (HR 1.47, 95% CI 1.18–1.81), CFS (HR 1.24, 95% CI 1.01–1.51) and EHR score (HR 1.26, 95% CI 1.03–1.55) independently predicted 90-day readmission or death, after adjustment for age, sex and comorbidity. All frailty instruments were independent predictors of 12-month mortality, with age, sex and comorbidity losing predictive power (p > 0.05) once frailty was included in modelling. Conclusions At hospital discharge, the Fried phenotype and CFS added to age and comorbidity in risk prediction for future unplanned readmission or death. EHR frailty markers appeared comparable to face-to-face assessment. An automated trigger for high-risk patients using routine EHR data merits prospective evaluation.

scholarly journals Electronic Health Record Use among Ophthalmology Residents while on Call

2020 ◽  
Vol 12 (02) ◽  
pp. e143-e150
Author(s):  
Christopher P. Long ◽  
Ming Tai-Seale ◽  
Robert El-Kareh ◽  
Jeffrey E. Lee ◽  
Sally L. Baxter
Keyword(s):  
Internal Medicine ◽  
Electronic Health Record ◽  
Chart Review ◽  
Health Record ◽  
Physician Burnout ◽  
Single Institution ◽  
Clinical Exposure ◽  
Future Studies ◽  
After Hours ◽  
Electronic Health

Abstract Background As electronic health record (EHR) use becomes more widespread, detailed records of how users interact with the EHR, known as EHR audit logs, are being used to characterize the clinical workflows of physicians including residents. After-hours EHR use is of particular interest given its known association with physician burnout. Several studies have analyzed EHR audit logs for residents in other fields, such as internal medicine, but none thus far in ophthalmology. Here, we focused specifically on EHR use during on-call shifts outside of normal clinic hours. Methods In this retrospective study, we analyzed raw EHR audit log data from on-call shifts for 12 ophthalmology residents at a single institution over the course of a calendar year. Data were analyzed to characterize total time spent using the EHR, clinical volume, diagnoses of patients seen on call, and EHR tasks. Results Across all call shifts, the median and interquartile range (IQR) of the time spent logged into the EHR per shift were 88 and 131 minutes, respectively. The median (IQR) unique patient charts accessed per shift was 7 (9) patients. When standardized to per-hour measures, weekday evening shifts were the busiest call shifts with regard to both EHR use time and clinical volume. Total EHR use time and clinical volume were greatest in the summer months (July to September). Chart review comprised a majority (63.4%) of ophthalmology residents' on-call EHR activities. Conclusion In summary, EHR audit logs demonstrate substantial call burden for ophthalmology residents outside of regular clinic hours. These data and future studies can be used to further characterize the clinical exposure and call burden of ophthalmology residents and could potentially have broader implications in the fields of physician burnout and education policy.

scholarly journals Are specific elements of electronic health record use associated with clinician burnout more than others?

2020 ◽  
Vol 27 (9) ◽  
pp. 1401-1410
Author(s):  
Ross W Hilliard ◽  
Jacqueline Haskell ◽  
Rebekah L Gardner
Keyword(s):  
Confidence Interval ◽  
Electronic Health Record ◽  
Odds Ratio ◽  
Adjusted Odds Ratio ◽  
Well Being ◽  
Health Record ◽  
Face To Face ◽  
Efficiency Measures ◽  
Electronic Health ◽  
Copy And Paste

Abstract Objective The study sought to examine the association between clinician burnout and measures of electronic health record (EHR) workload and efficiency, using vendor-derived EHR action log data. Materials and Methods We combined data from a statewide clinician survey on burnout with Epic EHR data from the ambulatory sites of 2 large health systems; the combined dataset included 422 clinicians. We examined whether specific EHR workload and efficiency measures were independently associated with burnout symptoms, using multivariable logistic regression and controlling for clinician characteristics. Results Clinicians with the highest volume of patient call messages had almost 4 times the odds of burnout compared with clinicians with the fewest (adjusted odds ratio, 3.81; 95% confidence interval, 1.44-10.14; P = .007). No other workload measures were significantly associated with burnout. No efficiency variables were significantly associated with burnout in the main analysis; however, in a subset of clinicians for whom note entry data were available, clinicians in the top quartile of copy and paste use were significantly less likely to report burnout, with an adjusted odds ratio of 0.22 (95% confidence interval, 0.05-0.93; P = .039). Discussion High volumes of patient call messages were significantly associated with clinician burnout, even when accounting for other measures of workload and efficiency. In the EHR, “patient calls” encompass many of the inbox tasks occurring outside of face-to-face visits and likely represent an important target for improving clinician well-being. Conclusions Our results suggest that increased workload is associated with burnout and that EHR efficiency tools are not likely to reduce burnout symptoms, with the exception of copy and paste.

scholarly journals Reducing electronic health record-related burnout in providers through a personalized efficiency improvement program

2020 ◽  
Author(s):  
Eli M Lourie ◽  
Levon Haig Utidjian ◽  
Maria F Ricci ◽  
Linda Webster ◽  
Carola Young ◽  
...  
Keyword(s):  
Electronic Health Record ◽  
Health Record ◽  
Efficiency Improvement ◽  
Improvement Program ◽  
Improve Efficiency ◽  
After Hours ◽  
The Mean ◽  
Net Promoter ◽  
Electronic Health ◽  
The One

Abstract Objective To give providers a better understanding of how to use the electronic health record (EHR), improve efficiency, and reduce burnout. Materials and Methods All ambulatory providers were offered at least 1 one-on-one session with an “optimizer” focusing on filling gaps in EHR knowledge and lack of customization. Success was measured using pre- and post-surveys that consisted of validated tools and homegrown questions. Only participants who returned both surveys were included in our calculations. Results Out of 1155 eligible providers, 1010 participated in optimization sessions. Pre-survey return rate was 90% (1034/1155) and post-survey was 54% (541/1010). 451 participants completed both surveys. After completing their optimization sessions, respondents reported a 26% improvement in mean knowledge of EHR functionality (P < .01), a 19% increase in the mean efficiency in the EHR (P < .01), and a 17% decrease in mean after-hours EHR usage (P < .01). Of the 401 providers asked to rate their burnout, 32% reported feelings of burnout in the pre-survey compared to 23% in the post-survey (P < .01). Providers were also likely to recommend colleagues participate in the program, with a Net Promoter Score of 41. Discussion It is possible to improve provider efficiency and feelings of burnout with a personalized optimization program. We ascribe these improvements to the one-on-one nature of our program which provides both training as well as addressing the feeling of isolation many providers feel after implementation. Conclusion It is possible to reduce burnout in ambulatory providers with personalized retraining designed to improve efficiency and knowledge of the EHR.

scholarly journals Resident Duty Hours in the Outpatient Electronic Health Record Era: Inaccuracies and Implications

2014 ◽  
Vol 6 (1) ◽  
pp. 151-154 ◽  
Author(s):  
Meghan Gilleland ◽  
Katherine Komis ◽  
Sonya Chawla ◽  
Stephen Fernandez ◽  
Mary Fishman ◽  
...  
Keyword(s):  
Internal Medicine ◽  
Electronic Health Record ◽  
Health Record ◽  
Duty Hours ◽  
General Internal ◽  
Resident Burnout ◽  
After Hours ◽  
Resident Duty ◽  
Electronic Health ◽  
Internal Medicine Clinic

Abstract Background The Accreditation Council for Graduate Medical Education expects resident duty hours to be monitored, yet no previous studies have examined the effect of after-hours electronic health record (EHR) use on resident hours or burnout. Objective We assessed internal medicine residents' perceived and actual time spent on after-hours outpatient EHR use and calculated increased duty hours if after-hours EHR use were included; we also assessed its effect on resident burnout. Methods We retrospectively aggregated time spent logged on to the outpatient EHR for residents in a general internal medicine clinic for 13 weeks in 2011. Residents completed a survey on EHR use, which was correlated with objectively recorded data on EHR usage. We compared actual and self-reported EHR time and identified violations that would be generated if these hours were included in reported duty hours. We also correlated resident after-hours EHR use with responses to an internally developed burnout survey. Results The 44 residents in this study overestimated time spent on the ambulatory EHR (they spent 3.03 hours/week on after-hours use compared with a recorded 1.20 hours/week). In total, 190 duty hour violations (mean duration of violation  =  37 minutes) would have been generated if after-hours EHR usage were included in residents' reported duty hours. Conclusions Resident estimates of EHR use by residents were not accurate; including after-hours EHR use would increase the number of reported duty hour violations. There was no association between after-hours EHR use and resident burnout.

scholarly journals Electronic health records and burnout: Time spent on the electronic health record after hours and message volume associated with exhaustion but not with cynicism among primary care clinicians

2020 ◽  
Vol 27 (4) ◽  
pp. 531-538 ◽  
Author(s):  
Julia Adler-Milstein ◽  
Wendi Zhao ◽  
Rachel Willard-Grace ◽  
Margae Knox ◽  
Kevin Grumbach
Keyword(s):  
Primary Care ◽  
Electronic Health Record ◽  
Academic Medical Center ◽  
Maslach Burnout Inventory ◽  
Health Record ◽  
Full Time ◽  
Full Time Equivalent ◽  
After Hours ◽  
Electronic Health ◽  
High Exhaustion

Abstract Objectives The study sought to determine whether objective measures of electronic health record (EHR) use—related to time, volume of work, and proficiency—are associated with either or both components of clinician burnout: exhaustion and cynicism. Materials and Methods We combined Maslach Burnout Inventory survey measures (94% response rate; 122 of 130 clinicians) with objective, vendor-defined EHR use measures from log files (time after hours on clinic days; time on nonclinic days; message volume; composite measures of efficiency and proficiency). Data were collected in early 2018 from all primary care clinics of a large, urban, academic medical center. Multivariate regression models measured the association between each burnout component and each EHR use measure. Results One-third (34%) of clinicians had high cynicism and 51% had high emotional exhaustion. Clinicians in the top 2 quartiles of EHR time after hours on scheduled clinic days (those above the sample median of 68 minutes per clinical full-time equivalent per week) had 4.78 (95% confidence interval [CI], 1.1-20.1; P = .04) and 12.52 (95% CI, 2.6-61; P = .002) greater odds of high exhaustion. Clinicians in the top quartile of message volume (>307 messages per clinical full-time equivalent per week) had 6.17 greater odds of high exhaustion (95% CI, 1.1-41; P = .04). No measures were associated with high cynicism. Discussion EHRs have been cited as a contributor to clinician burnout, and self-reported data suggest a relationship between EHR use and burnout. As organizations increasingly rely on objective, vendor-defined EHR measures to design and evaluate interventions to reduce burnout, our findings point to the measures that should be targeted. Conclusions Two specific EHR use measures were associated with exhaustion.

Electronic Health Record Workstation Single Sign-on

2020 ◽  
Vol 50 (9) ◽  
pp. 462-467
Author(s):  
George A. Gellert ◽  
Ricardo Ramirez ◽  
Walter J. Jacobs ◽  
Gabriel Maciaz
Keyword(s):  
Electronic Health Record ◽  
Health Record ◽  
Single Sign On ◽  
Electronic Health
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