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Do Electronic Medical Records Affect Productivity – Part 2

In case you didn’t catch the earlier version of this experiment that I posted, you can find that one here.

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 including …
–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.

13 Responses to “Do Electronic Medical Records Affect Productivity – Part 2”

  1. Antigonos says:

    How much of that excruciating amount of time on the computer was due to the program and how much to using antiquated computers? All hi-tech equipment becomes obsolete, or nearly so, so fast. Between 1997 and 2001 I worked for an Israeli startup as a midwifery consultant that was building an “intelligent” EMR for Labor and Delivery units in the States. At the time we felt we were working on old and slow computers, but when I was in the US for beta testing, the computers of the hospital were even older — and much slower. [In those days, 64 MB RAM was "fast", to give you an idea, and we were still using floppy discs]
    This, IMO, is a major problem with EMRs.

  2. JJ says:

    I am trying to figure out a way to get paid by the amount of time I spend staring at the hourglass flipping around or the number of times I see “deadlock resource victim” throughout the course of my day.

  3. Long Time E.D. Doc says:

    Meditech is a total nightmare. Just ask any physician who has ever been forced to use it It has little do with “the amount of RAM!” No disrespect intended to Antigonos and to the planet he is living on. This system took us from and E.D. with a minimal walk out rate and generally high patient satisfaction rates to one that is now horrible in both respects. Oh yeah, lots of stupid/potentially dangerous physician and nursing errors now too. The type of thing that never happened in the old school system. And this is after the learning curve.

    At first the administration kept asking how the E.D. was going to fix the problem. It’s a classic hospital admin scapegoat the E.D. strategy. Hard to make a strong case when it’s the E.D. staff doing poorly since it’s the same people doing the same job, only with a different tool now.

    And who made the descision to use the Meditech system? Oh yeah, it wasn’t anyone involved in the E.D. It was the super smart hospital administrators. Had they even bothered to use that inter-web searcher thingy called the google, (I am dumbing it down for them in case one should read this)they would have see how many other E.D.’s suffered the same consequences first. Good call, hospital admin types. Oh yeah, they did sort of finally apologize as the system continued to spin out of control. Still waiting to hear about the meaningful use dollars the hospital is supposed to get. I know we won’t see those dollars.

    Waiting for the train to finally run off the tracks. Why didn’t we speak up, get involved, be proactive, etc. some clever person is probably asking? (They probable also ask why the rape victims don’t fight back more…) We did that and were told in no uncertain terms to be quiet and just do our job. Call this a rant.

    Let’s hear the rest of the Meditech stories out there…

  4. pat says:

    so is it safe to assume that paper records would still require you to write orders/labs and complete discharge documentation? would you still not be looking at old medical records (waiting for a chart from the file room??), writing admit/transfer orders? so not all of this is “additional” time due to the EMR, some of the time would have been spent completing these tasks regardless of type of medical record?

    • ThorMD says:

      The difference is that it takes me 15 seconds to check all the necessary boxes in the paper record. Then the secretary who gets paid $20 an hour enters them. In the EMR, it takes me 50 clicks and 5 minutes to order the same amount of stuff. I get paid a little more than $20 an hour. One seems a lot more cost effective than the other. By my calculation, the secretary pays for itself if I see 1 patient per hour.

      Furthermore, it’s easier to multitask with a paper record. I can check boxes and write orders while I’m standing in the room with the patient. But I can’t do that as easily with the computer EMR. Again, if I glance down at my paper while talking to the patient and check some boxes, they don’t get upset if I lose eye contact for 10 seconds. But they get annoyed if I log onto the computer and look away from them for 3 minutes while clicking on the computer.

  5. JustADoc says:

    From the family doc point of view:
    I worked in an access clinic(reduced cost for low income patients) as a locums for awhile after residency and before joining my practice. It used paper charts. I saw 27-30 patients a day from 8a-5p with a 90 min lunch(which I took, left for lunch by 12:15 and got back minutes before 2pm). I was out the door with all charting done by the latest at 5:05pm every single day.

    I now have a wonderful EMR. In clinic from 9a-5p(with hospital beforehand) with 90 minute lunch. Rarely done with the AM clinic before 1pm and notes are never done by then. Lunch is maybe 20 minutes on average. Out of office 5:30-5:45 and frequently do some notes from home or come in early on days I have lower hospital census to do charting/paperwork(yeah, still lots of that with our ‘paperless’ system). So fewer patients seen in a longer time and have to do work when ‘off’ from home.
    BTW, it is no easier to hunt down an old ECHO/stress test/consultant note/last lipid panel/etc with the EMR than it was with a well-organized paper chart.
    And no, our EMR does not communicate with the hospital nor any local consultant.

  6. Anony says:

    Any opinions on the Epic Systems?

    • CodeBlue says:

      I trained with Epic and with Ibex. Ibex is terrible. It’s web-based, which necessarily means that you can only work on one patient at a time and you have to wait for the page to load for each change you make.

      Epic- while the ED template we were using was a bit cumbersome, and some of my colleagues had a backlog of charts, could be made very efficient. It benefitted and suffered from the ability to build text macros ie “advised the patient to follow up with their primary care provider. Pt verbalized understanding of all instructions given and agreed to return to ED with any worsening of symptoms.”
      I could add that to a chart with 3 key-presses. Of course, if you have too many macros, your chart becomes useless, as it looks just like all the other charts.
      Our hospital also got all the inpatient services and many of the local docs onto epic, which was fantastic, because I could see office notes and progress notes, which you can’t ordinarily see, and also outpatient testing not performed at the hospital.
      With a template that’s more like a t-sheet with an area for free-text MDM- Epic would be the bomb.

      I currently use a t-sheet with meditech for order entry and records. As mentioned above, meditech is slow, allows access to a single patient at a time, and often locks up. I have no major complaints about the t-sheet.
      Admin, in their infinite wisdom, is going to force Meditech charting on us at some point. Having seen the demo version and read online about it, I’m not looking forward to this. I’d almost rather do the t-sheet for my billers and coders and dictate for my inpatient colleagues (except that’s double work). meditech appears to produce a difficult to interpret, slow to generate, poorly formatted medical record that will not help anybody.

  7. Anony says:

    Nice to hear. I find Epic one of the better ones as opposed to the others out there too. Thanks for sharing!

  8. ksccts says:

    Meditech is multiple generations behind the current leaders, Cerner and Epic. No surprise you had terrible efficiency.

  9. JOHNWAT says:

    I jumped out of the frying pain and into the FIRE!
    The military has a good EMR in ALTA. It stunk at first, but thanks to an all hands effort (Doc, nurses, techs and IT personnel) it worked better than any I have used since. MEDIWRECK is dangerous and the programers have never spoke with any active practicing doctors.

  10. Doc Seal says:

    This is the result of physicians ceding authority to non-clinical CEOs/administrators and govt. bureaucrats. Despite the facade they put forward, the best interest of the patient is no longer the bottom line.

  11. Brian says:

    Here’s a funny take on CPOE in the ER using one of those enterprise systems. Exaggerated, but based on real examples from a vendor who shall not be named (except above in your post).

    http://vimeo.com/54299546

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