218 - EMR Efficiency at Varying Stages of Medical Education

Publication Number: 218.4826

Clinton Bunde, Indiana University School of Medicine, Indianapolis, IN, United States; Jessica Kanis, IU Health - - Indianapolis, IN, Indianapolis ,IN, USA, IN, United States

Background: Tasks in the electronic medical record (EMR) have increasingly consumed physicians time during scheduled work hours. Emergency medicine (EM) physicians spend on average 26-39% of their shift time completing EMR tasks, taking time away from patient care and education responsibilities. Prior studies have shown that first year residents spend on average 45 minutes in the EMR per patient, with 13.5% of EMR tasks completed after-hours. After 12 months in clinical practice, residents’ after-hours tasks didn’t show significant reduction in time. This indicates that while residents' clinical efficiency improves, their EMR efficiency is lagging and may require additional intervention. This leads to the question: are residents receiving sufficient EMR training and feedback to help them be successful and minimize after-hours charting burden?

Objective: To determine the relationship between how physicians utilize EMR time among varying levels of medical education and evaluated the need for individualized EMR training

Design/Methods: A retrospective review of EMR efficiency was performed on physicians who worked in the pediatric ED over a nine-month period. EMR vendor tracking metrics were used for data collection. Charting metrics include total time in chart, chart review, documentation, placing orders, and charting interruptions. Physicians were sorted into groups based on their level of medical training: residents, fellows, attendings. Data was analyzed with one way ANOVA. A Tukey-Kramer test was applied to establish significant difference between groups.

Results: We analyzed 143 residents, 9 fellows and 25 attendings. The resident group logged the most EMR time per patient in all categories and the attending group logged the least. There were significant increases in EMR usage for all efficiency metrics when comparing resident to both fellow and attending groups. Additionally, residents had more recorded charting interruptions across all groups.

Conclusion(s): Residents spent more time performing all tasks in the EMR compared to attendings, suggesting the need for different EMR training and targeted interventions to improve efficiency. Residents had more charting interruptions during EMR tasks than either fellows or attendings combined. These interruptions contributed to the resident group having double the total charting time compared to fellows and triple compared to attendings. Interruptions can be caused by inefficiencies or EMR needs for other patients. Customizing EMR trainings and workflows with resident physicians in mind will increase time for learning, patient care and decrease after-hour charting burden.

Average Efficiency Metrics Between Groups