I work at several hospitals and each uses a different electronic medical record system. When I switch from hospital one to another, I obviously have my favorite EMR systems and my not so favorite EMR systems. In the previous post, I was using the EMPOWER charting system, which I liked for its simplicity, but disliked because of the layouts of the charting interface and some of the macros it contained.
After becoming rather frustrated with the function of another EMR system, I decided to repeat the experiment at a different hospital. This hospital uses the Meditech system. I also did the same thing at a third hospital using yet another EMR. Those times will be published in a future post.
I had to do the experiment at this hospital a few times because several times I wasn’t consistently busy throughout the shifts as I am at other places. In the shift that I used, I only tracked 7 hours in an 8 hour shift because the first hour had a lot of down time that wouldn’t have fairly represented the effects of the EMR on my productivity. In general, the whole shift had rather low acuity with only a couple of admits. In theory, low acuity should increase efficiency because of less charting time. It didn’t. In fact, the percentage of time that I spent with patients during this low acuity shift was just slightly more than the percentage of time I spent with patients during a much higher acuity shift which required more documentation of several more admits and a transfer.
As with the previous experiment, when there was overlap, I would generally count the time toward the task with which I was focusing most — if I was speaking to a doctor on the phone while charting, I counted the time as only speaking to the doctor.
Out of a total of 420 minutes, I calculated that I spent the following amount of time performing the following tasks:
Seeing patients: 156 minutes
Time on computer: 237 minutes
- Charting/entering orders and labs to be done/entering discharge documentation: 191 minutes
- Looking up old medical records: 20 minutes
- Entering admit orders/completing transfer forms: 13 minutes
- Meditech program issues: 13 minutes
- Discussions with other physicians: 20 minutes
- Miscellaneous down time (bathroom, food, non-work related issues): 7 minutes
Despite a lower acuity shift, more than half of my time was spent on Meditech entering data. I should take that back. Thirteen minutes were wasted due to Meditech program freezes and due to watching the little hourglass turn over and over on the computer screen while Meditech’s pages loaded. The rest of the time was spent entering data.
I lumped patient evaluations and re-evaluations into one category, so I wasn’t able to calculate the total time I spent with each patient. However, based on the numbers, it appears that time with patients averaged between 6 and 10 minutes (with a couple of outliers)
Out of a seven hour shift, I spent just over 2.5 hours with my patients and their families and I spent just under 4 hours with the computer program.
Sad.
“WhiteCoat” is an emergency physician who blogs at WhiteCoat’s Call Room at Emergency Physicians Monthly.
