Study: Provider Experience Affects EHR Documentation Time

Feb. 4, 2019

It’s been widely-referenced that physicians spend large chunks of their days documenting patient encounters using electronic health records (EHRs), and now a new study has pointed to provider experience being a key factor in just how much time is spent.

The research, published recently in AHIMA’s Perspectives in Health Information Management, compared the time required to complete an emergency department note in two different EHR systems for three separate simulated patient encounters. The total time needed to complete documentation, including the time to write and order the initial history, physical exam, and diagnostic studies, and the time to provide medical decision making and disposition, were recorded and compared by trainee across training levels.

For the study, which took place at a three-year academic emergency medicine residency program, two EHR user interfaces were compared: Cerner’s FirstNet system, currently used in the hospital’s ED, and the Sparrow Emergency Department Information System, an EHR system that was unknown to all study participants.

According to the researchers, “The only significant difference in documentation time was by classification, with second- and third-year trainees being significantly faster in documenting on the Cerner system than fourth-year medical student and first-year trainees. Level of training and experience with a system affected documentation time.”

More specifically, the average time to document on the Cerner system was 15.9 minutes for MS4 (fourth-year medical) students, 13.6 minutes for first-year trainees, 11.2 minutes for second-year trainees, and 11.2 minutes for third-year trainees, with an overall average of 12.7 minutes for the Cerner system. The average time to document on the Sparrow system was 16.2 minutes for MS4 students, 14.6 minutes for first-year trainees, 13.2 minutes for second-year trainees, and 14.0 minutes for third-year trainees, with an overall average of 14.3 minutes for the Sparrow system.

“This finding suggests that the level of training and years of experience with a system have a significant effect on documentation time,” the researchers noted.”

What’s more, of the entire patient encounter time from initial evaluation to disposition, including documentation time, the percentage of time spent documenting was 63 percent, 56 percent, and 62 percent respectively for each patient encounter using the Cerner system and 67 percent, 58 percent, and 66 percent respectively for each patient encounter using the Sparrow system across all participants.

The study’s authors concluded, “The findings of our study are consistent with other studies evaluating physician documentation using EHRs. Studies have shown that emergency physicians spend 43 percent of their time on data entry and 28 percent in direct contact with patients, with time for electronic documentation ranging between 29 percent and 65 percent.”

They also added that studies looking at the efficiency of providers using scribes or alternative documentation services have shown improvement in work efficiency; moreover, these findings suggest that “an increased focus on early training of residents in documentation skills may lead to improvement in efficiency when other documentation services are not available.”