1.  The Impact of Electronic Health Records on Time Efficiency of Physicians and Nurses: A Systematic Review

Author(s): Poissant L, Pereira J, Tamblyn R, Kawasumi Y

Source: Journal of the American Medical Informatics Assocation (JAMIA). 2005 Sep-Oct;12(5):505-516 Epub 2005 May 19.

Summary: This systematic review examined the impact of electronic health records (EHRs) on documentation time of physicians and nurses. Twenty-three papers met our inclusion criteria; five were randomized controlled trials, six were posttest control studies, and 12 were one-group pretest-posttest designs. The use of bedside terminals and central station desktops saved nurses, respectively, 24.5% and 23.5% of their overall time spent documenting during a shift. Using bedside or point-of-care systems increased documentation time of physicians by 17.5%. In comparison, the use of central station desktops for computerized provider order entry (CPOE) was found to be inefficient, increasing the work time from 98.1% to 328.6% of physician's time per working shift.  Studies conducting their evaluation process relatively soon after implementation of the EHR tended to demonstrate a reduction in documentation time; studies with a longer interval between implementation and the evaluation process observed an increase in time.  This review highlighted that a goal of decreased documentation time in an EHR project is not likely to be realized.

2.  Primary Care Physician Time Utilization Before and After Implementation of an Electronic Health Record: A Time-motion Study

Author(s): Pizziferri L, Kittler AF, Volk LA, Honour MM, Gupta S, Wang S, Wang T, Lippincott M, Li Q, Bates DW

Source: Journal of Biomedical Informatics. 2005 Jun;38(3):176-188 Epub 2004 Dec 14.

Summary: Despite benefits associated with the use of electronic health records (EHRs), one major barrier to adoption is the concern that EHRs may take longer for physicians to use than paper-based systems. To address this issue, we performed a time-motion study in five primary care clinics. Twenty physicians were observed and specific activities were timed during a clinic session before and after EHR implementation. Post-implementation, the adjusted mean overall time spent per patient during clinic sessions decreased by 0.5 min (p=0.86; 95% confidence interval [-5.05, 6.04]) from a pre-intervention adjusted average of 27.55 min (SE=2.1) to a post-intervention adjusted average of 27.05 min (SE=1.6). A majority of survey respondents believed EHR use results in quality improvement, yet only 29% reported that EHR documentation takes the same amount of time or less compared to the paper-based system. While the EHR did not require more time for physicians during a clinic session, further studies should assess the EHR's potential impact on non-clinic time.