Characterizing Multitasking and Workflow Fragmentation in Electronic Health Records among Emergency Department Clinicians: Using Time-Motion Data to Understand Documentation Burden

Abstract Background The impact of electronic health records (EHRs) in the emergency department (ED) remains mixed. Dynamic and unpredictable, the ED is highly vulnerable to workflow interruptions. Objectives The aim of the study is to understand multitasking and task fragmentation in the clinical workflow among ED clinicians using clinical information systems (CIS) through time-motion study (TMS) data, and inform their applications to more robust and generalizable measures of CIS-related documentation burden. Methods Using TMS data collected among 15 clinicians in the ED, we investigated the role of documentation burden, multitasking (i.e., performing physical and communication tasks concurrently), and workflow fragmentation in the ED. We focused on CIS-related tasks, including EHRs. Results We captured 5,061 tasks and 877 communications in 741 locations within the ED. Of the 58.7 total hours observed, 44.7% were spent on CIS-related tasks; nearly all CIS-related tasks focused on data-viewing and data-entering. Over one-fifth of CIS-related task time was spent on multitasking. The mean average duration among multitasked CIS-related tasks was shorter than non-multitasked CIS-related tasks (20.7 s vs. 30.1 s). Clinicians experienced 1.4 ± 0.9 task switches/min, which increased by one-third when multitasking. Although multitasking was associated with a significant increase in the average duration among data-entering tasks, there was no significant effect on data-viewing tasks. When engaged in CIS-related task switches, clinicians were more likely to return to the same CIS-related task at higher proportions while multitasking versus not multitasking. Conclusion Multitasking and workflow fragmentation may play a significant role in EHR documentation among ED clinicians, particularly among data-entering tasks. Understanding where and when multitasking and workflow fragmentation occurs is a crucial step to assessing potentially burdensome clinician tasks and mitigating risks to patient safety. These findings may guide future research on developing more scalable and generalizable measures of CIS-related documentation burden that do not necessitate direct observation techniques (e.g., EHR log files).

Download Full-text

PCN345 Understanding the IMPACT of Assessment Frequency on the Study of Adverse Effects (AES) Using Oncology Electronic Health Records (EHRS)

Value in Health ◽

10.1016/j.jval.2020.08.482 ◽

2020 ◽

Vol 23 ◽

pp. S483-S484

Author(s):

Q. Liang ◽

Q. Zhang ◽

A. Rosic ◽

B. Bowser ◽

S. Tharani ◽

...

Keyword(s):

Adverse Effects ◽

Electronic Health Records ◽

Health Records ◽

Electronic Health ◽

Assessment Frequency ◽

The Impact

Download Full-text

Examining the impact of data quality and completeness of electronic health records on predictions of patients’ risks of cardiovascular disease

International Journal of Medical Informatics ◽

10.1016/j.ijmedinf.2019.104033 ◽

2020 ◽

Vol 133 ◽

pp. 104033 ◽

Cited By ~ 4

Author(s):

Yan Li ◽

Matthew Sperrin ◽

Glen P. Martin ◽

Darren M. Ashcroft ◽

Tjeerd Pieter van Staa

Keyword(s):

Cardiovascular Disease ◽

Electronic Health Records ◽

Data Quality ◽

Health Records ◽

Electronic Health ◽

The Impact

Download Full-text

The impact of electronic health records on healthcare quality: a systematic review and meta-analysis

European Journal of Public Health ◽

10.1093/eurpub/ckv122 ◽

2015 ◽

Vol 26 (1) ◽

pp. 60-64 ◽

Cited By ~ 77

Author(s):

Paolo Campanella ◽

Emanuela Lovato ◽

Claudio Marone ◽

Lucia Fallacara ◽

Agostino Mancuso ◽

...

Keyword(s):

Systematic Review ◽

Electronic Health Records ◽

Meta Analysis ◽

Healthcare Quality ◽

Health Records ◽

Electronic Health ◽

The Impact

Download Full-text

Research and application of artificial intelligence based on electronic health record data from patients with cancer: a systematic review (Preprint)

10.2196/preprints.33799 ◽

2021 ◽

Author(s):

Xinyu Yang ◽

Dongmei Mu ◽

Hao Peng ◽

Hua Li ◽

Ying Wang ◽

...

Keyword(s):

Artificial Intelligence ◽

Electronic Health Records ◽

Ensemble Methods ◽

Future Research ◽

Electronic Health Record Data ◽

Health Records ◽

Patients With Cancer ◽

Cancer Management ◽

Treatment And Prevention ◽

Electronic Health

BACKGROUND With the accumulation of electronic health records data and the development of artificial intelligence, patients with cancer urgently need new evidence of more personalized clinical and demographic characteristics and more sophisticated treatment and prevention strategies. However, no research has systematically analyzed the application and significance of electronic health records and artificial intelligence in cancer care. OBJECTIVE In this study, we reviewed the literature on the application of AI based on EHR data from patients with cancer, hoping to provide reference for subsequent researchers, and help accelerate the application of EHR data and AI technology in the field of cancer, so as to help patients get more scientific and accurate treatment. METHODS Three databases were systematically searched to retrieve potentially relevant articles published from January 2009 to October 2020. A combination of terms related to "electronic health records", "artificial intelligence" and "cancer" was used to search for these publications. RESULTS Of the 1034 articles considered, 148 met the inclusion criteria. The review has shown that ensemble methods and deep learning were on the rise. It presented the representative literatures on the subfield of cancer diagnosis, treatment and care. In addition, the vast majority of studies in this area were based on private institutional databases, resulting in poor portability of the proposed methodology process. CONCLUSIONS The use of new methods and electronic health records data sharing and fusion were recommended for future research. With the help of specialists, artificial intelligence and the mining of massive electronic medical records could provide great opportunities for improving cancer management.

Download Full-text

Using the Electronic Health Records to Measure, Monitor, and Evaluate the Impact of Integrated Care / El uso de los registros electrónicos de salud para medir, monitorear y evaluar el impacto de Atención Integral

International Journal of Integrated Care ◽

10.5334/ijic.2380 ◽

2015 ◽

Vol 15 (8) ◽

Author(s):

Hani Serag ◽

Wei-Chen Lee ◽

Kenneth D. Smith

Keyword(s):

Electronic Health Records ◽

Integrated Care ◽

Health Records ◽

Electronic Health ◽

The Impact

Download Full-text

Electronic health records in ambulances: the ERA multiple-methods study

Health Services and Delivery Research ◽

10.3310/hsdr08100 ◽

2020 ◽

Vol 8 (10) ◽

pp. 1-140

Author(s):

Alison Porter ◽

Anisha Badshah ◽

Sarah Black ◽

David Fitzpatrick ◽

Robert Harris-Mayes ◽

...

Keyword(s):

Emergency Department ◽

Health Services ◽

Electronic Health Records ◽

Case Studies ◽

Routine Data ◽

Health Economy ◽

Multiple Methods ◽

Health Records ◽

Electronic Health ◽

Future Work

Background Ambulance services have a vital role in the shift towards the delivery of health care outside hospitals, when this is better for patients, by offering alternatives to transfer to the emergency department. The introduction of information technology in ambulance services to electronically capture, interpret, store and transfer patient data can support out-of-hospital care. Objective We aimed to understand how electronic health records can be most effectively implemented in a pre-hospital context in order to support a safe and effective shift from acute to community-based care, and how their potential benefits can be maximised. Design and setting We carried out a study using multiple methods and with four work packages: (1) a rapid literature review; (2) a telephone survey of all 13 freestanding UK ambulance services; (3) detailed case studies examining electronic health record use through qualitative methods and analysis of routine data in four selected sites consisting of UK ambulance services and their associated health economies; and (4) a knowledge-sharing workshop. Results We found limited literature on electronic health records. Only half of the UK ambulance services had electronic health records in use at the time of data collection, with considerable variation in hardware and software and some reversion to use of paper records as services transitioned between systems. The case studies found that the ambulance services’ electronic health records were in a state of change. Not all patient contacts resulted in the generation of electronic health records. Ambulance clinicians were dealing with partial or unclear information, which may not fit comfortably with the electronic health records. Ambulance clinicians continued to use indirect data input approaches (such as first writing on a glove) even when using electronic health records. The primary function of electronic health records in all services seemed to be as a store for patient data. There was, as yet, limited evidence of electronic health records’ full potential being realised to transfer information, support decision-making or change patient care. Limitations Limitations included the difficulty of obtaining sets of matching routine data for analysis, difficulties of attributing any change in practice to electronic health records within a complex system and the rapidly changing environment, which means that some of our observations may no longer reflect reality. Conclusions Realising all the benefits of electronic health records requires engagement with other parts of the local health economy and dealing with variations between providers and the challenges of interoperability. Clinicians and data managers, and those working in different parts of the health economy, are likely to want very different things from a data set and need to be presented with only the information that they need. Future work There is scope for future work analysing ambulance service routine data sets, qualitative work to examine transfer of information at the emergency department and patients’ perspectives on record-keeping, and to develop and evaluate feedback to clinicians based on patient records. Study registration This study is registered as Health and Care Research Wales Clinical Research Portfolio 34166. Funding This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 8, No. 10. See the NIHR Journals Library website for further project information.

Download Full-text

The Promise of Electronic Health Records to Promote Shared Decision Making: A Narrative Review and a Look Ahead

Medical Decision Making ◽

10.1177/0272989x18796223 ◽

2018 ◽

Vol 38 (8) ◽

pp. 1040-1045 ◽

Cited By ~ 6

Author(s):

Alyce Mei-Shiuan Kuo ◽

Berry Thavalathil ◽

Glyn Elwyn ◽

Zsuzsanna Nemeth ◽

Stuti Dang

Keyword(s):

Decision Making ◽

Electronic Health Records ◽

Shared Decision Making ◽

Decisional Conflict ◽

Shared Decision ◽

Health Records ◽

Look Ahead ◽

The Face ◽

Electronic Health ◽

The Impact

Background. Shared decision making (SDM) involves the sharing of best available evidence between patients and providers in the face of difficult decisions. We examine outcomes that occur when electronic health records (EHRs) are purposefully used with the goal of improving SDM and detail which EHR functions can benefit SDM. Methods. A systematic search of PubMed yielded 1369 articles. Studies were included only if they used EHR interventions to support SDM and included results that showed impact on SDM. Articles were excluded if they did not measure the impact of the intervention on SDM or did not discuss how SDM had been supported by the EHR. Results. Five studies demonstrated improved clinical outcomes, positive lifestyle behavior changes, more deliberation from patients regarding use of imaging, and less decisional conflict about medication use among patients with use of EHRs aiding SDM. Discussion. Few EHRs have integrated SDM, and even fewer evaluations of these exist. EHRs have potential in supporting providers during all steps of SDM. The promise of EHRs to support SDM has yet to be fully exploited.

Download Full-text

The Impact of the Global, Extensible Electronic Health Record

Managing Healthcare Information Systems with Web-Enabled Technologies ◽

10.4018/978-1-878289-65-0.ch001 ◽

2011 ◽

pp. 3-13 ◽

Cited By ~ 2

Author(s):

David W. Forslund ◽

David G. Kilman

Keyword(s):

Electronic Health Records ◽

Negative Impact ◽

Global Scale ◽

Global Perspective ◽

Health Records ◽

Technological Advances ◽

The World ◽

Electronic Health ◽

The Impact

With the arrival of the “World Wide Web,” we have witnessed a transition toward a truly global perspective with respect to electronic health records. In recent years, much more discussion has focused on the potential for international virtual electronic health records and what is required for them to become a reality in the world today (Kilman & Forslund, 1997). As the Internet becomes more ubiquitous and Web-enabled, we see access to electronic health records using these technologies becoming more commonplace. Even so, these Web-enabled health records still remain technologically isolated from other medical records in the distributed continuum of care; much of the standardization challenge still stands before us. We have witnessed startling technological advances, but we still face considerable obstacles to the goal of having globally standardized electronic health records. In this chapter we describe some of the issues associated with Web-enabled health records, the role of standards in the evolution of Web-enabled health records, and some of the barriers to the development of globally accessible electronic health records. We discuss possible ways to overcome these barriers and the kinds of benefits and opportunities that global health records will help provide. The global scale perspective makes more evident the very real and potentially tragic consequences of prolonged and unnecessary delays in deploying these technologies. Therefore, in an effort to promote a fuller consciousness of health safety, the chapter concludes with a comparative look at the negative impact of impediments in the movement toward global extensible electronic health records.

Download Full-text