Quantifying temporal documentation patterns in clinician use of AHLTA-the DoD's ambulatory electronic health record

In this paper, we analyzed computer-recorded user interactions with AHLTA, the electronic health record (EHR) used by the Department of Defense, to study clinicians' temporal documentation behavior in their use of the system in their daily clinical practice. We collected one week of AHLTA usage data via a monitoring software program installed in 35,570 clinical workstations across 138 military treatment facilities. The data allowed us to quantify the temporal relations among sentinel events that represent two distinct phases of clinical documentation: initiating a patient encounter and finalizing the patient note. The results suggest that alternative EHR documentation strategies such as deferred documentation were commonly employed by clinicians. The incidence rates of encounter initiation and finalization were significantly disproportional across time of day. Lunchtime and late afternoon catch-up activities were clearly delineated. While alternative documentation is a known tactic employed by clinicians, it has not been rigorously quantified in previous research.