scholarly journals Easing hospitalist electronic health record burden through clinical workstation single sign-on

2020 ◽  
Vol 9 (3) ◽  
pp. 24
Author(s):  
George A. Gellert ◽  
Crystal Delacerda ◽  
Lajja Patel ◽  
Gabriel Maciaz
Keyword(s):  
Electronic Health Record ◽  
Patient Care ◽  
Health Record ◽  
Hourly Wage ◽  
Single Sign On ◽  
Annual Range ◽  
National Estimates ◽  
Computer Workstation ◽  
Electronic Health ◽  
Clinical Workstation

Background: Computer workstation single sign-on (SSO) was implemented in 19 hospitals to reduce manual keyboard login and expedite access to the electronic health record (EHR) and clinical applications.Objective: To quantify hospitalists time liberated from EHR keyboard to focus on patient care, and estimate financial value of this time for hospitalists.Methods: Login duration prior to and after SSO implementation were compared in eight hospitals. Using national estimates of hospitalist hourly wage, dollar values of time liberated from keyboard were calculated, stratified by different levels of total EHR use.Results: Following SSO implementation, first of shift login decreased 5.3 seconds (15.3%), and reconnect duration decreased 20.4 seconds (69.9%). The volume of hospitalist EHR use among all physician end users comprises 70%-90% of all electronic documentation and clinical orders issued, yielding an annual range of 10,302 hours (or 858.5 12-hour shifts) to 13,245 hours (or 1,103.8 12-hour shifts) in hospitalist time liberated from keyboard for patient care, with recurrent annual value of $1,164,126 to $1,496,685.Conclusions: Hospitalists gained meaningful amounts of time for patient care from SSO implementation. This time accrued to substantial financial value. SSO eases the EHR burden of hospitalists, and facilities using hospitalists extensively should consider SSO implementation.

scholarly journals I-THS-1908 A Big Data Electronic Health Record for Patient Care Management and Analytics

2019 ◽  
Author(s):  
Ahmad Hidayat ◽  
Arief Hasani
Keyword(s):  
Big Data ◽  
Electronic Health Record ◽  
Patient Care ◽  
Care Management ◽  
Patient Care Management ◽  
Health Conditions ◽  
Health Record ◽  
Complex Variety ◽  
Electronic Health ◽  
Further Development

The I-THS-1908, a big data electronic health record platform, is capable of establishing its capability as an electronic health record to tackle the large volume of data with high velocity and complex variety of patient data by providing the value to the patient care management and analytics. The further development of I-THS-1908 opens the opportunity to use the electronic health record for patient care management and analytics for all type of health conditions.

scholarly journals Electronic Health Record Adoption – Maybe It’s not about the Money

2011 ◽  
Vol 02 (04) ◽  
pp. 460-471 ◽  
Author(s):  
A. Skinner ◽  
J. Windle ◽  
L. Grabenbauer
Keyword(s):  
Electronic Health Record ◽  
Patient Care ◽  
Resistance To Change ◽  
Medical Center ◽  
Academic Medical Center ◽  
Care Physician ◽  
Health Record ◽  
Record System ◽  
Intuitive Interfaces ◽  
Electronic Health

SummaryObjective: The slow adoption of electronic health record (EHR) systems has been linked to physician resistance to change and the expense of EHR adoption. This qualitative study was conducted to evaluate benefits, and clarify limitations of two mature, robust, comprehensive EHR Systems by tech-savvy physicians where resistance and expense are not at issue.Methods: Two EHR systems were examined – the paperless VistA / Computerized Patient Record System used at the Veterans‘ Administration, and the General Electric Centricity Enterprise system used at an academic medical center. A series of interviews was conducted with 20 EHR-savvy multi-institutional internal medicine (IM) faculty and house staff. Grounded theory was used to analyze the transcribed data and build themes. The relevance and importance of themes were constructed by examining their frequency, convergence, and intensity.Results: Despite eliminating resistance to both adoption and technology as drivers of acceptance, these two robust EHR’s are still viewed as having an adverse impact on two aspects of patient care, physician workflow and team communication. Both EHR’s had perceived strengths but also significant limitations and neither were able to satisfactorily address all of the physicians’ needs.Conclusion: Difficulties related to physician acceptance reflect real concerns about EHR impact on patient care. Physicians are optimistic about the future benefits of EHR systems, but are frustrated with the non-intuitive interfaces and cumbersome data searches of existing EHRs.

scholarly journals The Use of Electronic Health Record Systems During COVID-19 at a Local Community Hospital on the West Coast

2021 ◽  
pp. 53-58
Author(s):  
Malini Krishnamurthi, Ph.D.
Keyword(s):  
Health Care ◽  
Electronic Health Record ◽  
Patient Care ◽  
Data Privacy ◽  
Local Community ◽  
Quality Care ◽  
The United States ◽  
Health Record ◽  
Privacy And Security ◽  
Electronic Health

The United States Federal government looks toward information technology to curtail health care costs while increasing the quality of patient care through the adoption of electronic health record (EHR)systems. This paper examined the experience of a hospital with its EHR system in the context of the pandemic. Results showed that the hospital maintains a state-of-the-art health care system to provide quality care to its community and was responsive to the recent crisis. The results were consistent with other comparable hospitals examined in this study. The hospitals were successful in adopting EHR systems. They were able to identify gaps that could be filled with technology add-ons from different software vendors to improve their functionality and thereby provide better & timely patient care. Managing large volumes of data generated in the normal process of EHR operation and ensuring data privacy and security were the significant challenges faced and are likely to continue in the future.

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.

Novel Nonproprietary Measures of Ambulatory Electronic Health Record Use Associated with Physician Work Exhaustion

2021 ◽  
Vol 12 (03) ◽  
pp. 637-646
Author(s):  
Amrita Sinha ◽  
Tait D. Shanafelt ◽  
Mickey Trockel ◽  
Hanhan Wang ◽  
Christopher Sharp
Keyword(s):  
Electronic Health Record ◽  
Patient Care ◽  
Dominant Factor ◽  
Health Record ◽  
Occupational Burnout ◽  
Electronic Health ◽  
Perception Of Time ◽  
Professional Fulfillment ◽  
The Impact ◽  
Physician Work

Abstract Background Accumulating evidence indicates an association between physician electronic health record (EHR) use after work hours and occupational distress including burnout. These studies are based on either physician perception of time spent in EHR through surveys which may be prone to bias or by utilizing vendor-defined EHR use measures which often rely on proprietary algorithms that may not take into account variation in physician's schedules which may underestimate time spent on the EHR outside of scheduled clinic time. The Stanford team developed and refined a nonproprietary EHR use algorithm to track the number of hours a physician spends logged into the EHR and calculates the Clinician Logged-in Outside Clinic (CLOC) time, the number of hours spent by a physician on the EHR outside of allocated time for patient care. Objective The objective of our study was to measure the association between CLOC metrics and validated measures of physician burnout and professional fulfillment. Methods Physicians from adult outpatient Internal Medicine, Neurology, Dermatology, Hematology, Oncology, Rheumatology, and Endocrinology departments who logged more than 8 hours of scheduled clinic time per week and answered the annual wellness survey administered in Spring 2019 were included in the analysis. Results We observed a statistically significant positive correlation between CLOC ratio (defined as the ratio of CLOC time to allocated time for patient care) and work exhaustion (Pearson's r = 0.14; p = 0.04), but not interpersonal disengagement, burnout, or professional fulfillment. Conclusion The CLOC metrics are potential objective EHR activity-based markers associated with physician work exhaustion. Our results suggest that the impact of time spent on EHR, while associated with exhaustion, does not appear to be a dominant factor driving the high rates of occupational burnout in physicians.

scholarly journals Time Spent on Dedicated Patient Care and Documentation Tasks Before and After the Introduction of a Structured and Standardized Electronic Health Record

2018 ◽  
Vol 09 (01) ◽  
pp. 046-053 ◽  
Author(s):  
Erik Joukes ◽  
Ameen Abu-Hanna ◽  
Ronald Cornet ◽  
Nicolette de Keizer
Keyword(s):  
Electronic Health Record ◽  
Patient Care ◽  
Time Distribution ◽  
Health Record ◽  
University Hospitals ◽  
Peer Communication ◽  
Significant Difference ◽  
Before And After ◽  
Electronic Health ◽  
Multilevel Linear Regression

Background Physicians spend around 35% of their time documenting patient data. They are concerned that adopting a structured and standardized electronic health record (EHR) will lead to more time documenting and less time for patient care, especially during consultations. Objective This study measures the effect of the introduction of a structured and standardized EHR on documentation time and time for dedicated patient care during outpatient consultations. Methods We measured physicians' time spent on four task categories during outpatient consultations: documentation, patient care, peer communication, and other activities. Physicians covered various specialties from two university hospitals that jointly implemented a structured and standardized EHR. Preimplementation, one hospital used a legacy-EHR, and one primarily paper-based records. The same physicians were observed 2 to 6 months before and 6 to 8 months after implementation.We analyzed consultation duration, and percentage of time spent on each task category. Differences in time distribution before and after implementation were tested using multilevel linear regression. Results We observed 24 physicians (162 hours, 439 consultations). We found no significant difference in consultation duration or number of consultations per hour. In the legacy-EHR center, we found the implementation associated with a significant decrease in time spent on dedicated patient care (−8.5%). In contrast, in the previously paper-based center, we found a significant increase in dedicated time spent on documentation (8.3%) and decrease in time on combined patient care and documentation (−4.6%). The effect on dedicated documentation time significantly differed between centers. Conclusion Implementation of a structured and standardized EHR was associated with 8.5% decrease in time for dedicated patient care during consultations in one center and 8.3% increase in dedicated documentation time in another center. These results are in line with physicians' concerns that the introduction of a structured and standardized EHR might lead to more documentation burden and less time for dedicated patient care.

Identification of Design Criteria to Improve Patient Care in Electronic Health Record Downtime

2019 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Ethan P. Larsen ◽  
Ali Haskins Lisle ◽  
Bethany Law ◽  
Joseph L. Gabbard ◽  
Brian M. Kleiner ◽  
...  
Keyword(s):  
Electronic Health Record ◽  
Patient Care ◽  
Improve Patient Care ◽  
Design Criteria ◽  
Health Record ◽  
Electronic Health ◽  
Improve Patient
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