Efficiency of Emergency Physicians: Insights from an Observational Study using EHR Log Files

Area of Science:

• Health Informatics
• Emergency Medicine
• Clinical Efficiency

Background:

• Electronic health records (EHR) are widely used in clinical care following federal mandates.
• Perspectives on EHR impact vary, necessitating further investigation into their effects on healthcare operations.
• Understanding EHR utilization patterns is crucial for optimizing emergency department (ED) workflows.

Purpose of the Study:

• To investigate the relationship between specific EHR activities and ED throughput and efficiency.
• To analyze how physician time spent on EHR tasks affects key ED performance metrics.
• To identify potential associations between EHR use and patient care timeliness.

Main Methods:

• Collected EHR log data detailing physician activities (documentation, review, orders, navigation) for 2,304 patient encounters over 6 weeks.
• Captured four ED performance metrics: door-to-provider time, door-to-doctor time, door-to-disposition time, and length of stay (LOS).
• Statistically evaluated the correlation between EHR activity durations and ED performance metrics.

Main Results:

• A positive correlation was found between time spent by physicians reviewing patient charts in the EHR and increased door-to-disposition time (r=0.43, p<0.05).
• Physician chart review time also positively correlated with longer patient length of stay (LOS) (r=0.48, p<0.05).
• No other statistically significant associations were identified between EHR activities and the measured ED performance metrics.

Conclusions:

• Extended physician engagement with EHR chart review may negatively impact ED throughput efficiency.
• Balancing comprehensive EHR information review with timely patient care presents a significant challenge for physicians.
• The findings suggest potential implications for patient safety that warrant further discussion and research.