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Methods of Documentation VII: EMR01:30

Methods of Documentation VII: EMR

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Electronic Medical Records (EMRs) primarily center around electronically documenting patients' health information within a single healthcare organization or practice. They contain essential clinical data related to a patient's medical history, diagnoses, medications, treatment plans, lab results, and other pertinent information relevant to the specific encounter or episode of care. EMRs are designed to streamline documentation and workflow processes within individual healthcare...
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Explaining Variability in Electronic Health Record Effort in Primary Care Ambulatory Encounters.

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Applied Clinical Informatics
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This summary is machine-generated.

Electronic health record (EHR) usage varies most at the individual physician level, not the practice or health system level. Interventions targeting individual EHR users may be most effective for improving efficiency.

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Area of Science:

  • Health Informatics
  • Medical Informatics
  • Clinical Informatics

Background:

  • Electronic health record (EHR) event logs offer insights into EHR technology's value and efficiency.
  • Analyzing EHR usage data can identify design factors impacting user efficiency, satisfaction, and burnout.

Purpose of the Study:

  • To analyze EHR event log data from 26 health systems.
  • To determine variability in EHR use across individual, practice group, and health system levels.
  • To assess four key EHR event log metrics: Active EHR Time, Documentation Time, Chart Review Time, and Ordering Time.

Main Methods:

  • Collected de-identified EHR event log data from 2,285 primary care practices within 26 health systems.
  • Analyzed data from 5,444 physicians (Family and Internal Medicine) between June 2018 and May 2019.
  • Estimated variability in EHR usage metrics at individual, practice, and health system levels.

Main Results:

  • Individual physicians accounted for the largest proportion of variability in EHR usage metrics (17.09% to 27.49%).
  • Practice-level variability ranged from 5.57% to 13.52%, while health system-level variability was lower (1.29% to 3.55%).
  • Significant differences in Active EHR Time, Documentation Time, Chart Review Time, and Ordering Time were observed across physicians.

Conclusions:

  • Physician EHR usage patterns exhibit the highest variability at the individual level, decreasing at practice and health system levels.
  • Interventions focused on improving individual EHR user efficiency hold the most potential for impact.
  • Tailoring efficiency improvements to individual physician workflows may be more effective than system-wide changes.