Experience Has Big Effect on EHR Documentation Time

When it comes to electronic health record documentation, new research suggests the clinician user’s familiarity with an EHR matters more than the “usability” of the system itself.

Investigators from Texas Tech University Health Sciences Center El Paso sought to find out whether a new, “user-friendly” EHR interface would result in quicker documentation times among clinicians training in emergency medicine. To find out, they asked 47 volunteers from a three-year emergency medicine residency program to participate in three simulated emergency department visits, which were all timed. After viewing the simulation, participants input documentation for the first two visits using the Cerner FirstNet system, a computer-based program currently in use at the hospital, or the Sparrow Emergency Department Information System, an iPad-based system that was new to study participants. After completing documentation in one of the two EHR systems, participants completed the third documentation using the other system.

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Investigators found that the system didn’t make as much difference as the user’s level of experience. Participants in their second and third years of residency performed EHR documentation more quickly than fourth-year medical students and first-year residents. That effect held true, though to a lesser extent, even on the Sparrow system, which was new to all participants.

“The main takeaway that we could identify from the study data was that years of training had the most consistent impact on speed of data entry using either system, and the system that was known and familiar to learners was overall faster,” said Scott Crawford, M.D., the study’s corresponding author, who specializes in emergency medicine at Texas Tech.

Although the Sparrow interface did not appear to result in faster input times, a majority of users said they preferred that system.

Crawford said the research has implications for how EHR training ought to be conducted.

“Currently, training for many EHR systems involves sitting in a classroom setting and mirroring the instructions from a lecturer,” he said.

Such lecture-style training might be necessary to introduce specific features, but Crawford said the data suggest it’s better to give hands-on training through the use of simulations.

Medical students and residents should also get training using EHRs in real-life patient encounters.

“One additional benefit of incorporating EHR training in student training is helping care providers to maintain a personal interaction while working with a computer system for both review of information and documentation of information,” he said.

That extra practice will help new physicians become experienced in EHR documentation sooner, meaning they might also work quicker, according to Crawford’s findings.

Of course, EHR systems are bound to change over time. But even if those changes are made with usability in mind, clinicians will need plenty of practice.

“The example that could be applied from this study is a massive change in layout and location to access and enter or retrieve implementation, even if believed to be more efficient (such as was the idea with the intervention EHR evaluated), will actually slow productivity initially, but this impact is likely more pronounced for new clinicians and care providers than those who may have more familiarity with what and how to document,” he said.

Crawford’s study, “Electronic Health Record Documentation Times Among Emergency Medicine Trainees,” was published in the winter edition of Perspectives in Health Information Management.

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