The impact of electronic health record systems on clinical documentation times: A systematic review

•Impact of electronic health record (EHR) use on documentation time was examined.•EHR implementation associated with increased documentation time for hospital staff.•A need for longer follow-up of EHR impact is highlighted.•Multitasking and interruptions to staff work flow is a concern to patient sa...

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Veröffentlicht in:	Health policy (Amsterdam) Jg. 122; H. 8; S. 827 - 836
Hauptverfasser:	Baumann, Lisa Ann, Baker, Jannah, Elshaug, Adam G.
Format:	Journal Article
Sprache:	Englisch
Veröffentlicht:	Ireland Elsevier B.V 01.08.2018 Elsevier Science Ltd
Schlagworte:	Administrative burden Citations Confidence intervals Criteria Documentation Documentation - statistics & numerical data Efficiency Electronic health record Electronic Health Records Health care policy Health services Hospital staff Hospitals Humans Long term Medical personnel Medical records Meta-analysis Nurses Patient Care Patient Care Team - statistics & numerical data Patients Physicians Quality of care Quality of Health Care Records management Selection criteria Systematic review Time Time Factors Trust Workload - statistics & numerical data Administrative burden Efficiency Documentation Systematic review Electronic health record Hospital staff Meta-analysis
ISSN:	0168-8510, 1872-6054, 1872-6054
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Abstract	•Impact of electronic health record (EHR) use on documentation time was examined.•EHR implementation associated with increased documentation time for hospital staff.•A need for longer follow-up of EHR impact is highlighted.•Multitasking and interruptions to staff work flow is a concern to patient safety.•Adaptation to EHR over time could potentially solve inefficiencies in work flow. Effective management of hospital staff time is crucial to quality patient care. Recent years have seen widespread implementation of electronic health record (EHR) systems but the effect of this on documentation time is unknown. This review compares time spent on documentation tasks by hospital staff (physicians, nurses and interns) before and after EHR implementation. A systematic search identified 8153 potentially relevant citations. Studies examining proportion of total workload spent on documentation with ≥40 h of staff observation time were included. Meta-analysis was performed for physicians, nurses and interns comparing pre- and post-EHR results. Studies were weighted by person-hours observation time. Twenty-eight studies met selection criteria. Seventeen were pre-EHR, nine post-EHR and two examined both periods. With implementation of EHR, physicians’ documentation time increased from 16% (95% confidence interval (CI) 11–22%) to 28% (95% CI 19–37%), nurses from 9% (95% CI 6–12%) to 23% (95% CI 15–32%) and interns from 20% (95% CI 7–32%) to 26% (95% CI 10–42%). There is a lack of long-term follow-up on the effects of EHR implementation. Initial adjustment to EHR appears to increase documentation time but there is some evidence that as staff become more familiar with the system, it may ultimately improve work flow.
AbstractList	Effective management of hospital staff time is crucial to quality patient care. Recent years have seen widespread implementation of electronic health record (EHR) systems but the effect of this on documentation time is unknown. This review compares time spent on documentation tasks by hospital staff (physicians, nurses and interns) before and after EHR implementation.BACKGROUNDEffective management of hospital staff time is crucial to quality patient care. Recent years have seen widespread implementation of electronic health record (EHR) systems but the effect of this on documentation time is unknown. This review compares time spent on documentation tasks by hospital staff (physicians, nurses and interns) before and after EHR implementation.A systematic search identified 8153 potentially relevant citations. Studies examining proportion of total workload spent on documentation with ≥40 h of staff observation time were included. Meta-analysis was performed for physicians, nurses and interns comparing pre- and post-EHR results. Studies were weighted by person-hours observation time.METHODSA systematic search identified 8153 potentially relevant citations. Studies examining proportion of total workload spent on documentation with ≥40 h of staff observation time were included. Meta-analysis was performed for physicians, nurses and interns comparing pre- and post-EHR results. Studies were weighted by person-hours observation time.Twenty-eight studies met selection criteria. Seventeen were pre-EHR, nine post-EHR and two examined both periods. With implementation of EHR, physicians' documentation time increased from 16% (95% confidence interval (CI) 11-22%) to 28% (95% CI 19-37%), nurses from 9% (95% CI 6-12%) to 23% (95% CI 15-32%) and interns from 20% (95% CI 7-32%) to 26% (95% CI 10-42%).RESULTSTwenty-eight studies met selection criteria. Seventeen were pre-EHR, nine post-EHR and two examined both periods. With implementation of EHR, physicians' documentation time increased from 16% (95% confidence interval (CI) 11-22%) to 28% (95% CI 19-37%), nurses from 9% (95% CI 6-12%) to 23% (95% CI 15-32%) and interns from 20% (95% CI 7-32%) to 26% (95% CI 10-42%).There is a lack of long-term follow-up on the effects of EHR implementation. Initial adjustment to EHR appears to increase documentation time but there is some evidence that as staff become more familiar with the system, it may ultimately improve work flow.CONCLUSIONSThere is a lack of long-term follow-up on the effects of EHR implementation. Initial adjustment to EHR appears to increase documentation time but there is some evidence that as staff become more familiar with the system, it may ultimately improve work flow. •Impact of electronic health record (EHR) use on documentation time was examined.•EHR implementation associated with increased documentation time for hospital staff.•A need for longer follow-up of EHR impact is highlighted.•Multitasking and interruptions to staff work flow is a concern to patient safety.•Adaptation to EHR over time could potentially solve inefficiencies in work flow. Effective management of hospital staff time is crucial to quality patient care. Recent years have seen widespread implementation of electronic health record (EHR) systems but the effect of this on documentation time is unknown. This review compares time spent on documentation tasks by hospital staff (physicians, nurses and interns) before and after EHR implementation. A systematic search identified 8153 potentially relevant citations. Studies examining proportion of total workload spent on documentation with ≥40 h of staff observation time were included. Meta-analysis was performed for physicians, nurses and interns comparing pre- and post-EHR results. Studies were weighted by person-hours observation time. Twenty-eight studies met selection criteria. Seventeen were pre-EHR, nine post-EHR and two examined both periods. With implementation of EHR, physicians’ documentation time increased from 16% (95% confidence interval (CI) 11–22%) to 28% (95% CI 19–37%), nurses from 9% (95% CI 6–12%) to 23% (95% CI 15–32%) and interns from 20% (95% CI 7–32%) to 26% (95% CI 10–42%). There is a lack of long-term follow-up on the effects of EHR implementation. Initial adjustment to EHR appears to increase documentation time but there is some evidence that as staff become more familiar with the system, it may ultimately improve work flow. Background: Effective management of hospital staff time is crucial to quality patient care. Recent years have seen widespread implementation of electronic health record (EHR) systems but the effect of this on documentation time is unknown. This review compares time spent on documentation tasks by hospital staff (physicians, nurses and interns) before and after EHR implementation. Methods: A systematic search identified 8153 potentially relevant citations. Studies examining proportion of total workload spent on documentation with ≥40 h of staff observation time were included. Meta-analysis was performed for physicians, nurses and interns comparing pre- and post-EHR results. Studies were weighted by person-hours observation time. Results: Twenty-eight studies met selection criteria. Seventeen were pre-EHR, nine post-EHR and two examined both periods. With implementation of EHR, physicians’ documentation time increased from 16% (95% confidence interval (CI) 11–22%) to 28% (95% CI 19–37%), nurses from 9% (95% CI 6–12%) to 23% (95% CI 15–32%) and interns from 20% (95% CI 7–32%) to 26% (95% CI 10–42%). Conclusions: There is a lack of long-term follow-up on the effects of EHR implementation. Initial adjustment to EHR appears to increase documentation time but there is some evidence that as staff become more familiar with the system, it may ultimately improve work flow. Effective management of hospital staff time is crucial to quality patient care. Recent years have seen widespread implementation of electronic health record (EHR) systems but the effect of this on documentation time is unknown. This review compares time spent on documentation tasks by hospital staff (physicians, nurses and interns) before and after EHR implementation. A systematic search identified 8153 potentially relevant citations. Studies examining proportion of total workload spent on documentation with ≥40 h of staff observation time were included. Meta-analysis was performed for physicians, nurses and interns comparing pre- and post-EHR results. Studies were weighted by person-hours observation time. Twenty-eight studies met selection criteria. Seventeen were pre-EHR, nine post-EHR and two examined both periods. With implementation of EHR, physicians' documentation time increased from 16% (95% confidence interval (CI) 11-22%) to 28% (95% CI 19-37%), nurses from 9% (95% CI 6-12%) to 23% (95% CI 15-32%) and interns from 20% (95% CI 7-32%) to 26% (95% CI 10-42%). There is a lack of long-term follow-up on the effects of EHR implementation. Initial adjustment to EHR appears to increase documentation time but there is some evidence that as staff become more familiar with the system, it may ultimately improve work flow.
Author	Baumann, Lisa Ann Baker, Jannah Elshaug, Adam G.
Author_xml	– sequence: 1 givenname: Lisa Ann surname: Baumann fullname: Baumann, Lisa Ann email: lbaumann@uni-bremen.de organization: University of Bremen, University of Bremen, Bibliothekstraße 1, 28359, Bremen, Germany – sequence: 2 givenname: Jannah surname: Baker fullname: Baker, Jannah email: jbaker1@georgeinstitute.org.au organization: Menzies Centre for Health Policy, Sydney School of Public Health, The University of Sydney, NSW 2006, Australia – sequence: 3 givenname: Adam G. surname: Elshaug fullname: Elshaug, Adam G. email: elshaug@sydney.edu.au organization: Menzies Centre for Health Policy, Sydney School of Public Health, The University of Sydney, NSW 2006, Australia
BackLink	https://www.ncbi.nlm.nih.gov/pubmed/29895467$$D View this record in MEDLINE/PubMed
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Copyright	2018 Elsevier B.V. Copyright © 2018 Elsevier B.V. All rights reserved. Copyright Elsevier Science Ltd. Aug 2018
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A work-sampling analysis of physicians' activities publication-title: Methods of Information in Medicine doi: 10.3414/ME0569
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Snippet	•Impact of electronic health record (EHR) use on documentation time was examined.•EHR implementation associated with increased documentation time for hospital... Effective management of hospital staff time is crucial to quality patient care. Recent years have seen widespread implementation of electronic health record... Background: Effective management of hospital staff time is crucial to quality patient care. Recent years have seen widespread implementation of electronic...
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SubjectTerms	Administrative burden Citations Confidence intervals Criteria Documentation Documentation - statistics & numerical data Efficiency Electronic health record Electronic Health Records Health care policy Health services Hospital staff Hospitals Humans Long term Medical personnel Medical records Meta-analysis Nurses Patient Care Patient Care Team - statistics & numerical data Patients Physicians Quality of care Quality of Health Care Records management Selection criteria Systematic review Time Time Factors Trust Workload - statistics & numerical data
Title	The impact of electronic health record systems on clinical documentation times: A systematic review
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