Emergency Medicine Resident Physicians’ Perceptions of Electronic Documentation and Workflow

P.M. Neri; L. Redden; S. Poole; C.N. Pozner; J. Horsky; A.S. Raja; E. Poon; G. Schiff; A. Landman

doi:10.4338/ACI-2014-08-RA-0065

Applied Clinical Informatics, Table of Contents

Appl Clin Inform 2015; 06(01): 27-41
DOI: 10.4338/ACI-2014-08-RA-0065

Research Article

Schattauer GmbH

Emergency Medicine Resident Physicians’ Perceptions of Electronic Documentation and Workflow

A mixed methods study

P.M. Neri

¹Clinical & Quality Analysis, Partners HealthCare System, Wellesley, MA

,

L. Redden

¹Clinical & Quality Analysis, Partners HealthCare System, Wellesley, MA

,

S. Poole

²Brigham and Women’s Hospital, Boston, MA

³Neil and Elise Wallace STRATUS Center for Medical Simulation

⁴Simulation Consulting, Phoenix, Arizona, USA

,

C.N. Pozner

²Brigham and Women’s Hospital, Boston, MA

³Neil and Elise Wallace STRATUS Center for Medical Simulation

⁵Harvard Medical School, Boston, MA

,

J. Horsky

²Brigham and Women’s Hospital, Boston, MA

⁵Harvard Medical School, Boston, MA

,

A.S. Raja

²Brigham and Women’s Hospital, Boston, MA

⁵Harvard Medical School, Boston, MA

,

E. Poon

⁶Boston Medical Center, Boston University School of Medicine, Boston, MA

,

G. Schiff

²Brigham and Women’s Hospital, Boston, MA

⁵Harvard Medical School, Boston, MA

,

A. Landman

²Brigham and Women’s Hospital, Boston, MA

⁵Harvard Medical School, Boston, MA

› Author Affiliations

Abstract

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Keywords

Workflow - electronic documentation - emergency department - electronic health records

References

References
1 Meaningful Use Stage 2 Overview Tipsheet. 2012 ; Available from: http://www.cms.gov/Regulations-andGuidance/Legislation/EHRIncentivePrograms/Downloads/Stage2Overview_Tipsheet.
2 Landman AB, Bernstein SL, Hsiao AL, Desai RA. Emergency Department Information System Adoption in the United States. Acad Emerg Med 2010; 17 (05) 536-544. doi: 10.1111/j.1553–2712.2010.00722.x.
3 Kellermann AL, Jones SS. What it will take to achieve the as-yet-unfulfilled promises of health information technology. Health Aff (Millwood). 2013; 32 (01) 63-68. Epub 2013/01/09. doi: 10.1377/hlthaff.2012.0693. PubMed PMID: 23297272.
4 Middleton B, Bloomrosen M, Dente MA, Hashmat B, Koppel R, Overhage JM, Payne TH, Rosenbloom ST, Weaver C, Zhang J. Enhancing patient safety and quality of care by improving the usability of electronic health record systems: recommendations from AMIA. J Am Med Inform Assoc. 2013 doi: 10.1136/amiajnl-2012-001458.
5 Poissant L, Pereira J, Tamblyn R, Kawasumi Y. The impact of electronic health records on time efficiency of physicians and nurses: a systematic review. J Am Med Inform Assoc 2005; 12 (05) 505-516. Epub 2005/05/21. doi: 10.1197/jamia. M1700. PubMed PMID: 15905487; PubMed Central PMCID: PMCPmc1205599.
6 Ammenwerth E, Spotl HP. The time needed for clinical documentation versus direct patient care. A work-sampling analysis of physicians’ activities. Methods Inf Med 2009; 48 (01) 84-91. Epub 2009/01/20. PubMed PMID: 19151888.
7 Kim CS, Lovejoy W, Paulsen M, Chang R, Flanders SA. Hospitalist time usage and cyclicality: opportunities to improve efficiency. J Hosp Med 2010; 5 (06) 329-334. Epub 2010/08/31. doi: 10.1002/jhm.613. PubMed PMID: 20803670.
8 Oxentenko AS, West CP, Popkave C, Weinberger SE, Kolars JC. Time spent on clinical documentation: a survey of internal medicine residents and program directors. Arch Intern Med 2010; 170 (04) 377-380. Epub 2010/02/24. doi: 10.1001/archinternmed.2009.534. PubMed PMID: 20177042.
9 Perry JJ, Sutherland J, Symington C, Dorland K, Mansour M, Stiell IG. Assessment of the impact on time to complete medical record using an electronic medical record versus a paper record on emergency department patients: a study. Emerg Med J. 2013 Epub 2013/08/27. doi: 10.1136/emermed-2013–202479. PubMed PMID: 23975593.
10 Park SY, Lee SY, Chen Y. The effects of EMR deployment on doctors’ work practices: A qualitative study in the emergency department of a teaching hospital. Int J Med Inform 2012; 81 (03) 204-217. doi: 10.1016/j.ijmedinf.2011.12.001.
11 Chisholm CD, Collison EK, Nelson DR, Cordell WH. Emergency Department Workplace Interruptions Are Emergency Physicians “Interrupt-driven” and “Multitasking”?. Acad Emerg Med. 2000; 7 (11) 1239-1243. doi: 10.1111/j.1553–2712.2000.tb00469.x.
12 Weigl M, Muller A, Zupanc A, Angerer P. Participant observation of time allocation, direct patient contact and simultaneous activities in hospital physicians. BMC health services research 2009; 9: 110. Epub 2009/07/01. doi: 10.1186/1472–6963–9–110. PubMed PMID: 19563625; PubMed Central PMCID: PMC2709110.
13 Chisholm CD, Weaver CS, Whenmouth L, Giles B. A task analysis of emergency physician activities in academic and community settings. Ann Emerg Med 2011; 58 (02) 117-122. Epub 2011/02/01. doi: 10.1016/j.annemergmed.2010.11.026. PubMed PMID: 21276642.
14 Hockberger RS. The Model of the Clinical Practice of Emergency Medicine. Acad Emerg Med 2001; 8 (06) 660-681. doi: 10.1111/j.1553–2712.2001.tb00182.x.
15 Schiff GD, Bates DW. Can electronic clinical documentation help prevent diagnostic errors?. N Engl J Med 2010; 362 (12) 1066-1069. Epub 2010/03/26. doi: 10.1056/NEJMp0911734. PubMed PMID: 20335582.
16 Overhage JM, Perkins S, Tierney WM, McDonald CJ. Controlled trial of direct physician order entry: effects on physicians’ time utilization in ambulatory primary care internal medicine practices. J Am Med Inform Assoc 2001; 8 (04) 361-371. Epub 2001/06/22. PubMed PMID: 11418543; PubMed Central PMCID: PMCPmc130081.
17 Sofaer S. Qualitative methods: what are they and why use them?. Health Serv Res. 1999; 34 (5 Pt 2): 1101-18. Epub 1999/12/11. PubMed PMID: 10591275; PubMed Central PMCID: PMCPmc1089055.
18 Nielsen J. Why you only need to test with 5 users Alertbox2000. Available from: http://www.useit.com/alertbox/20000319.html
19 Virzi RA. Refining the test phase of usability evaluation: how many subjects is enough?. Hum Factors 1992; 34 (04) 457-468.
20 Faulkner L. Beyond the five-user assumption: Benefits of increased sample sizes in usability testing. Behavior Research Methods, Instruments, & Computers 2003; 35 (03) 379-383.
21 Patton MQ. Qualitative Research & Evaluation Methods. 3rd ed. Thousand Oaks, CA: SAGE Publications, Inc.; 2002
22 Landman AB, Redden L, Neri P, Poole S, Horsky J, Raja AS, Pozner CN, Schiff G, Poon EG. Using a medical simulation center as an electronic health record usability laboratory. J Am Med Inform Assoc. 2013 doi: 10.1136/amiajnl-2013–002233. PubMed PMID: 24249778.
23 Lawton K, Binzer K, Skjoet P, Jensen S. Lessons Learnt from Conducting a High Fidelity Simulation Test in Health IT. Patient Safety Informatics 2011; 166: 217-226.
24 Rothenhaus T, Kamens D, Keaton BF, Nathanson L, Nielson J, McClay JC, Taylor TB, Vallarin A. Emergency Department Information Systems: Primer for Emergency Physicians, Nurses, and IT Professionals. American College of Emergency Physicians: Resolution 22(07) Task Force White Paper. 2009. Available from: http://apps.acep.org/WorkArea/DownloadAsset.aspx?id=45756
25 Glaser B, Strauss A. The Discovery of Grounded Theory: Strategies for Qualitative Research. Chicago, IL: Aldine Transaction; 1967
26 Ancker JS, Kern LM, Edwards A, Nosal S, Stein DM, Hauser D, Kaushal R. How is the electronic health record being used? Use of EHR data to assess physician-level variability in technology use. J Am Med Inform Assoc. 2014 doi: 10.1136/amiajnl-2013-002627.
27 Diana A. Marathon Bombing Lessons: Boston Hospital Revamps Information Systems –Information-Week. InformationWeek [Internet]. 2014. Available from: http://www.informationweek.com/healthcare/clinical-information-systems/marathon-bombing-lessons-boston-hospital-revamps-information-systems/d/d-id/1234846.
28 Landman A, Teich JM, Pruitt P, Moore SE, Theriault J, Dorisca E, Harris S, Crim H, Lurie N, Goralnick E. The Boston Marathon Bombings Mass Casualty Incident: One Emergency Department’s Information Systems Challenges and Opportunities. Ann Emerg Med. 2014. Epub 2014/07/07. doi: 10.1016/j.anne-mergmed.2014.06.009. PubMed PMID: 24997562.
29 Hilligoss B, Zheng K. Chart biopsy: an emerging medical practice enabled by electronic health records and its impacts on emergency department-inpatient admission handoffs. J Am Med Inform Assoc 2013; 20 (02) 260-267. Epub 2012/09/11. doi: 10.1136/amiajnl-2012–001065. PubMed PMID: 22962194; PubMed Central PMCID: PMCPmc3638186.
30 Weir CR, Hurdle JF, Felgar MA, Hoffman JM, Roth B, Nebeker JR. Direct text entry in electronic progress notes. An evaluation of input errors. Methods Inf Med 2003; 42 (01) 61-67. Epub 2003/04/16. doi: 10.1267/meth03010061. PubMed PMID: 12695797.
31 O’Donnell HC, Kaushal R, Barron Y, Callahan MA, Adelman RD, Siegler EL. Physicians’ Attitudes Towards Copy and Pasting in Electronic Note Writing. J Gen Intern Med 2009; 24 (01) 63-68. doi: 10.1007/s11606–008–0843–2. PubMed PMID: 18998191; PubMed Central PMCID: PMC2607489.
32 Zalis M, Harris M. Advanced search of the electronic medical record: augmenting safety and efficiency in radiology. J Am Coll Radiol 2010; 7 (08) 625-633. Epub 2010/08/04. doi: 10.1016/j.jacr.2010.03.011. PubMed PMID: 20678732.
33 QPID™ | Media Coverage 2014. Available from: http://www.qpidhealth.com/category/media-coverage.
34 Linder JA, Schnipper JL, Tsurikova R, Yu T, Volk LA, Melnikas AJ, Palchuk MB, Olsha-Yehiav M, Middleton B. Documentation-based clinical decision support to improve antibiotic prescribing for acute respiratory infections in primary care: a cluster randomised controlled trial. Inform Prim Care 2009; 17 (04) 231-240. Epub 2010/04/03. PubMed PMID: 20359401.
35 Schnipper JL, Linder JA, Palchuk MB, Einbinder JS, Li Q, Postilnik A, Middleton B. „Smart Forms“ in an Electronic Medical Record: documentation-based clinical decision support to improve disease management. J Am Med Inform Assoc 2008; 15 (04) 513-523. doi: M2501 [pii] 10.1197/jamia. M2501. PubMed PMID: 18436911; PubMed Central PMCID: PMCPMC2442258.
36 Schnipper JL, Linder JA, Palchuk MB, Yu DT, McColgan KE, Volk LA, Tsurikova R, Melnikas AJ, Ein-binder JS, Middleton B. Effects of documentation-based decision support on chronic disease management. Am J Manag Care 2010; 16 12 Suppl. HIT SP72-SP81. doi: 12789 [pii]. PubMed PMID: 21314226.
37 Horsky J, Allen MB, Wilcox AR, Pollard SE, Neri P, Pallin DJ, Rothschild J.. Analysis of user behavior in accessing electronic medical record systems in emergency departments. AMIA Annu Symp Proc 2010; 2010: 311-315. PubMed PMID: 21346991; PubMed Central PMCID: PMCPMC3041327.

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