Background: Hospitalists spend a significant part of their workday interacting with the electronic medical record (EMR). Less is known regarding the details of the tasks that are performed during this interaction. In considering aspects of workflow and EMR usability, we sought to characterize how hospitalists spend time within the EMR, in terms of number of times records were opened, number of orders, navigation between tabs, and total time spent.
Methods: Our institution has a mature hospitalist practice. The start of the work day varies, and new admissions can be received until 4 PM on non-call days. Data were retrieved from audit logs reflecting care between October 2016 and June 2017. Active time in the EMR was detected and defined by prespecified thresholds of clicks, mouse movement and keystrokes. Tab hops are the count of tab navigation instances within a medical record. “Patients seen” were defined as the number of patients for whom a physician signed at least one note on a given day.
Descriptive statistics were summarized for variables including the duration of work day defined as the last active time minus the first active time, total active time (excludes inactive time), number of orders placed, tab hop counts, and number of records opened. The association between the total active time and the number of patients seen was based on univariate analysis of variance (ANOVA) models using generalized estimating equations (GEE) to account for the multiple records per physician. The associations between the number of patients seen and order counts, tab hop counts, and record open counts were also based on the GEE model. The study was reviewed and approved by the Institutional Review Board.
Results: Physicians (N=24) yielded 2191 workdays for analysis. On average, physicians saw 17 patients per day. Table 1 shows the descriptive statistics. The number of patients was significantly associated with number of orders tab hops, and record openings (p-value <0.004 for all). Record openings averaged 4 per physician per patient per day. With each additional patient seen, the order count increased by 5, the number of tab hops increased by 12, and number of records opened increased by 2.
Conclusions: Hospitalists spent nearly 4 hours (33%) of their work day actively working in the EMR. This time represents a significant burden, potentially detracting from time spent with patients. The numerous tab hops and multiple openings of records per patient—reflecting a combination of EMR usability and human workflow—suggest an opportunity to streamline and better organize the flow of work, potentially improving efficiency and safety of care.
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