Residents who use EHRs provide less direct patient care

Electronic health record use reduces direct patient care time and changes clinician workflow, even among medical residents, according to a new study in Laryngoscope, published by the American Laryngological, Rhinological and Otological Society.

The researchers, from the Baylor College of Medicine, speculated whether EHRs would affect workflow and resident training, and whether the evaluation of time utilization could help to better understand physician and resident workflow. They conducted a time motion study of eight residents in both second and fourth post-graduate years.

The study showed that on clinic days residents who used EHRs spent "significantly" less time on direct patient care and more on indirect care, such as increased time documenting into the EHR and reading results in the EHR (48.6 percent of indirect time using EHR vs. 38.4 percent using paper). Workflow also was more fragmented when residents used an EHR.

Other studies have found that EHRs change physician workflow and reduce direct patient interaction, much to the chagrin of physicians. While it can be argued that younger users may be more adept at and supportive of EHRs, their use and acceptance of EHRs is not universal even within that age group.

Interestingly, EHRs also did not significantly reduce the amount of time residents allocated to marginal activities that don't contribute to their educational hours, such as administrative work and technical problems.

The researchers suggested that user-interface design was contributing to more time spent documenting and that data entry be simplified to help minimize disruptions.

"EHR systems can alter how otolaryngology residents spend their time in the era of duty hour standards of the Accreditation Council for Graduate Medical Education," the researchers concluded. "Efforts should be made to optimize the implementation process of an EHR in an academic setting, particularly with regard to its potential impact on resident education and training."

To learn more:
- read the abstract