Using electronic health records system not burdensome.

SAN FRANCISCO -- Adopting an electronic health records system reduced the mean length of visits at five outpatient clinics by 4 minutes per patient, a difference that was not statistically significant but that should allay physicians' fears that the technology might be a burden, Lisa Pizziferri said.

The results come from a time-motion study in which observers shadowed primary care physicians before and after implementation of the electronic health records (EHR) system and timed their activities, she said in a poster presentation at the triennial congress of the International Medical Informatics Association.

They studied 20 physicians before EHR implementation, 16 of those after adoption of the system, and 4 newly recruited physicians after EHR implementation, for a total of 20 physicians before and after the system change. The urban and suburban outpatient clinics included neighborhood health centers, hospital-based practices, and community practices.

Talking to or examining a patient (direct patient care) took about 14 minutes in the pre-EHR era of paper-based records and 13 minutes using EHR, said Ms. Pizziferri of Partners HealthCare System Inc., Wellesley, Mass.

Indirect patient care, which involved reading, writing, or other tasks in support of direct patient care, took 9 minutes before EHR and 10 minutes after EHR. Physicians spent about half a minute reviewing schedules before EHR and 1 minute with EHR. Time spent eating, walking, or performing other miscellaneous tasks decreased from 4 minutes to 3 minutes per patient after EHR implementation.

The mean overall time spent with each patient decreased by 4 minutes, and was calculated independently, not by adding up the times of individual tasks, she said. During an average 4-hour observation period per physician, physicians saw 9 patients while using paper records and 10 patients while using EHR.

Asked to rate their experiences with the EHR system on a five-point scale (with five being the best), physicians rated its impact on quality, access, and communication a four. "Physicians recognized the quality improvement achieved by electronic health records," Ms. Pizziferri said.

The physicians rated the impact of EHR on workload at 3 and overall satisfaction at 4.

Partners HealthCare designed the Web-based EHR system, called the Longitudinal Medical Record. It includes patient clinical data, computerized decision support, reminders for health maintenance, and tools for charting, order entry, and management of results or referrals.

E-mail surveys of the physicians suggested that the time they spent on documentation outside of clinic hours increased from 9 to 10 minutes per established patient after EHR. Future research should study the impact of EHR on nonclinic time, she said.

BY SHERRY BOSCHERT

San Francisco Bureau