David S Sanders1, Sarah Read-Brown1, Daniel C Tu2, William E Lambert3, Dongseok Choi3, Bella M Almario1, Thomas R Yackel4, Anna S Brown1, Michael F Chiang5. 1. Department of Ophthalmology, Casey Eye Institute, Oregon Health & Science University, Portland. 2. Department of Ophthalmology, Casey Eye Institute, Oregon Health & Science University, Portland2Operative Care Division, Ophthalmology, Portland VA Medical Center, Portland, Oregon. 3. Department of Public Health and Preventive Medicine, Oregon Health & Science University, Portland. 4. Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland. 5. Department of Ophthalmology, Casey Eye Institute, Oregon Health & Science University, Portland4Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland.
Abstract
IMPORTANCE: Although electronic health record (EHR) systems have potential benefits, such as improved safety and quality of care, most ophthalmology practices in the United States have not adopted these systems. Concerns persist regarding potential negative impacts on clinical workflow. In particular, the impact of EHR operating room (OR) management systems on clinical efficiency in the ophthalmic surgery setting is unknown. OBJECTIVE: To determine the impact of an EHR OR management system on intraoperative nursing documentation time, surgical volume, and staffing requirements. DESIGN, SETTING, AND PARTICIPANTS: For documentation time and circulating nurses per procedure, a prospective cohort design was used between January 10, 2012, and January 10, 2013. For surgical volume and overall staffing requirements, a case series design was used between January 29, 2011, and January 28, 2013. This study involved ophthalmic OR nurses (n = 13) and surgeons (n = 25) at an academic medical center. EXPOSURES: Electronic health record OR management system implementation. MAIN OUTCOMES AND MEASURES: (1) Documentation time (percentage of operating time documenting [POTD], absolute documentation time in minutes), (2) surgical volume (procedures/time), and (3) staffing requirements (full-time equivalents, circulating nurses/procedure). Outcomes were measured during a baseline period when paper documentation was used and during the early (first 3 months) and late (4-12 months) periods after EHR implementation. RESULTS: There was a worsening in total POTD in the early EHR period (83%) vs paper baseline (41%) (P < .001). This improved to baseline levels by the late EHR period (46%, P = .28), although POTD in the cataract group remained worse than at baseline (64%, P < .001). There was a worsening in absolute mean documentation time in the early EHR period (16.7 minutes) vs paper baseline (7.5 minutes) (P < .001). This improved in the late EHR period (9.2 minutes) but remained worse than in the paper baseline (P < .001). While cataract procedures required more circulating nurses in the early EHR (mean, 1.9 nurses/procedure) and late EHR (mean, 1.5 nurses/procedure) periods than in the paper baseline (mean, 1.0 nurses/procedure) (P < .001), overall staffing requirements and surgical volume were not significantly different between the periods. CONCLUSIONS AND RELEVANCE: Electronic health record OR management system implementation was associated with worsening of intraoperative nursing documentation time especially in shorter procedures. However, it is possible to implement an EHR OR management system without serious negative impacts on surgical volume and staffing requirements.
IMPORTANCE: Although electronic health record (EHR) systems have potential benefits, such as improved safety and quality of care, most ophthalmology practices in the United States have not adopted these systems. Concerns persist regarding potential negative impacts on clinical workflow. In particular, the impact of EHR operating room (OR) management systems on clinical efficiency in the ophthalmic surgery setting is unknown. OBJECTIVE: To determine the impact of an EHR OR management system on intraoperative nursing documentation time, surgical volume, and staffing requirements. DESIGN, SETTING, AND PARTICIPANTS: For documentation time and circulating nurses per procedure, a prospective cohort design was used between January 10, 2012, and January 10, 2013. For surgical volume and overall staffing requirements, a case series design was used between January 29, 2011, and January 28, 2013. This study involved ophthalmic OR nurses (n = 13) and surgeons (n = 25) at an academic medical center. EXPOSURES: Electronic health record OR management system implementation. MAIN OUTCOMES AND MEASURES: (1) Documentation time (percentage of operating time documenting [POTD], absolute documentation time in minutes), (2) surgical volume (procedures/time), and (3) staffing requirements (full-time equivalents, circulating nurses/procedure). Outcomes were measured during a baseline period when paper documentation was used and during the early (first 3 months) and late (4-12 months) periods after EHR implementation. RESULTS: There was a worsening in total POTD in the early EHR period (83%) vs paper baseline (41%) (P < .001). This improved to baseline levels by the late EHR period (46%, P = .28), although POTD in the cataract group remained worse than at baseline (64%, P < .001). There was a worsening in absolute mean documentation time in the early EHR period (16.7 minutes) vs paper baseline (7.5 minutes) (P < .001). This improved in the late EHR period (9.2 minutes) but remained worse than in the paper baseline (P < .001). While cataract procedures required more circulating nurses in the early EHR (mean, 1.9 nurses/procedure) and late EHR (mean, 1.5 nurses/procedure) periods than in the paper baseline (mean, 1.0 nurses/procedure) (P < .001), overall staffing requirements and surgical volume were not significantly different between the periods. CONCLUSIONS AND RELEVANCE: Electronic health record OR management system implementation was associated with worsening of intraoperative nursing documentation time especially in shorter procedures. However, it is possible to implement an EHR OR management system without serious negative impacts on surgical volume and staffing requirements.
Authors: Joshua R Ehrlich; Monica Michelotti; Taylor S Blachley; Kai Zheng; Mick P Couper; Grant M Greenberg; Sharon Kileny; Greta L Branford; David A Hanauer; Jennifer S Weizer Journal: Appl Clin Inform Date: 2016-10-12 Impact factor: 2.342
Authors: Sarah Read-Brown; Michelle R Hribar; Leah G Reznick; Lorinna H Lombardi; Mansi Parikh; Winston D Chamberlain; Steven T Bailey; Jessica B Wallace; Thomas R Yackel; Michael F Chiang Journal: JAMA Ophthalmol Date: 2017-11-01 Impact factor: 7.389
Authors: C Mitsch; P Huber; K Kriechbaum; C Scholda; G Duftschmid; T Wrba; U Schmidt-Erfurth Journal: Appl Clin Inform Date: 2015-07-29 Impact factor: 2.342
Authors: Yasaira Rodriguez Torres; Jordan Huang; Melanie Mihlstin; Mark S Juzych; Heidi Kromrei; Frank S Hwang Journal: PLoS One Date: 2017-09-21 Impact factor: 3.240
Authors: Karsten Kortüm; Christoph Hirneiß; Michael Müller; Alexander Babenko; Anselm Kampik; Thomas C Kreutzer Journal: BMC Med Inform Decis Mak Date: 2016-07-26 Impact factor: 2.796