Eyeworld

March 2018 • Ophthalmology Business 17 A s a physician, if you think that you're spending a good portion of your day entering data and making notes on an electronic record system, you may be right. According to a recent study, 1 ophthalmologists spent a significant portion of their patient visits using the electronic health record (EHR). The research found that the average time ophthalmologists at a single center spent in an exam with the patient was 11.2 minutes; 3 of those minutes—or 27% of the examination time—was spent on the EHR. "What we found striking is that it's a significant percentage of a fairly short patient encounter," said Michael Chiang, MD, Knowles professor of ophthalmology and medical informatics and clinical epidemiology, Oregon Health and Science University, Portland, Oregon, and corresponding author of the study. The research was spurred by physicians complaining about the amount of time they were spending on EHR, reducing their efficiency, Dr. Chiang said. In the study, researchers followed five attending ophthalmologists from different subspecialties at an academ- ic center for at least 5 half-days over the course of a few months, record- ing the amount of time they spent in a patient examination and how long they used the EHR, were in con- versation with the patient, or were actively examining the patient. This amounted to 363 patient encounters. The researchers then collected timestamp data for these patient encounters (a patient encounter was clocked from the time they checked in until they checked out) using EHR audit logs, comparing the timestamp data against the findings of the in-person observations. This analysis validated the previously described manual observations and proved more practical for large scale data col- lection and analysis than the manual observation approach. This approach was used over the course of a year to evaluate 27 attending ophthalmologists who logged 46,000 patient encounters. EHR timestamps showed that these physicians were spending, on aver- age, 10.8 minutes total using the EHR per patient—5.9 minutes during the patient encounter and 4.9 minutes after it. "What we take from this is that it's a lot of time spent on the EHR. When we do the math … it's roughly 3.7 hours per full clinic day spent using the EHR," Dr. Chiang said. Half-day clinic volume and com- plexity (identified via primary billing code) were also analyzed in the context of time spent on the EHR. Physicians who saw a higher vol- ume of patients spent less time per patient on the EHR (but more total time) compared to those who saw a lower volume of patients. Ophthal- mologists who saw more complex cases (judged based on billing code) spent more time per patient on the EHR (but less total time) compared to those with less complex cases. Study reveals how much time ophthalmologists at a single center spent using EHR; more research needed to draw conclusions about the field as a whole continued on page 18

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