Efficiency of emergency physicians: insights from an observational study using EHR log files
Open accessAbstract
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.
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- Authors
- Kannampallil, T., Denton, C., Shapiro, J., & Patel, V.
- Affiliations
- University of Illinois Chicago (US)
- New York Academy of Medicine (US)
- Icahn School of Medicine at Mount Sinai (US)
- Venue
- Applied Clinical Informatics
- Publisher
- Georg Thieme Verlag KG
- Published
- 2018-01
- Volume
- 09
- Issue
- 01
- Pages
- 099-104
- ISSN
- 1869-0327 (ISSN-L)
- PMC
- PMC5802998
- OpenAlex
- W2786131978
- Cited by
- 27
- References
- 33
- Citations by year
- 2026: 2 · 2025: 2 · 2024: 3 · 2023: 3 · 2022: 5 · 2021: 5 · 2020: 3 · 2019: 3 · 2018: 1
- FWCI
- 3.78
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Applied Clinical Informatics (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Agency for Healthcare Research and Quality (R01HS022670)
- Topics
- Health Sciences › Health Professions › Health Information Management › Electronic Health Records Systems
- Health Sciences › Medicine › Emergency Medicine › Emergency and Acute Care Studies
- Health Sciences › Medicine › Emergency Medicine › Hospital Admissions and Outcomes
- Keywords
- electronic health records, emergency department throughput, emergency physicians, length of hospital stay, clinical documentation
- MeSH terms
- Adult, Documentation, Emergency Service, Hospital, Humans, Longevity, Physicians, Time Factors, Electronic Health Records, Observational Studies as Topic
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