Does autotext usage decrease documentation time among resident physicians? A retrospective analysis of electronic...

Area of Science:

• Medical Informatics
• Healthcare Management
• Clinical Documentation

Background:

• Autotext, or "dotphrases," are widely used in electronic health records (EHRs).
• Their impact on documentation time for resident physicians in inpatient settings is not well understood.
• This study investigates autotext usage and its effect on resident physician documentation time.

Purpose of the Study:

• To evaluate the association between autotext usage and documentation time among resident physicians.
• To identify factors influencing documentation time in an academic medical center.

Main Methods:

• A linear regression analysis was performed on data from 705 resident physicians.
• Data spanned July 2021 to June 2023 at a large academic medical center.
• Controlled for specialty, postgraduate year (PGY), gender, and patient volume.

Main Results:

• No significant overall association was found between autotext executions per patient and documentation time per patient in Dynamic Documentation workflows.
• Residents who did not use autotext experienced increased documentation time compared to those who did.
• This effect was mediated by the use of personalized autotexts; specialty, PGY, gender, and patient volume significantly impacted documentation time.

Conclusions:

• Encouraging autotext adoption can reduce resident physician documentation time.
• Focusing solely on increasing autotext usage beyond initial adoption yields no further time benefits.
• Further research is needed on other documentation time determinants and autotext's impact on note quality.