Vascular surgery residents spend one fifth of their time on electronic health records after duty hours

Faisal Aziz, Lauren Talhelm, Jeremy Keefer, Conrad Krawiec

Research output: Contribution to journalArticle

Abstract

Objective: Electronic health records (EHR) have largely replaced paper-based medical records. Academic institutions have adapted EHR successfully and technological innovations now allow remote access. Thus, self-reported resident duty hours may not accurately reflect the actual time that is spent on patient care-related activities. Methods: This retrospective observational study quantified vascular surgery resident EHR activities between January 2016 and June 2016 at a tertiary care hospital. Use time was tracked from user login to logout, divided by day of the week, and separated by EHR tasks performed. Each 24-hour time period was further divided into on-duty (6:00 AM to 6:00 PM) and off-duty (6:00 PM to 6:00 AM) hours. On-call weekdays and rotations that occurred off campus were excluded. The following EHR activity data were requested: total time, chart review time, documentation time, electronic order entry, patient discovery, and electronic messages. Results: A total of 11,812 charts were accessed: 80.5% on weekdays and 19.5% on weekends. Total time spent (hours:minutes:seconds, weekday percentage, weekend percentage) on EHR during this time period was 634:33:36 (81.2%, 18.8%). On weekdays, 79% of the EHR time was during the work hours and 21% after hours. On weekends, 78% of the EHR time was during work hours and 22% after hours. Time spent on different EHR tasks was as follows: chart review 278:58:34, documentation 66:33:07, electronic order entry 120:50:24, electronic messaging 2:16:48, problem list modification 1:49:26, electronic messages 4:30:43, patient discovery 151:14:53, and other 164:05:17. Overall, postgraduate year 1 residents spent the most number of hours on EHRs and during the weekdays. There was serial decrease in the total number of EHR hours and the number of weekday hours with the seniority of the residents, with postgraduate year 5 residents spending the least number of overall hours and weekday hours on the EHR. When EHR access was compared with self-reported duty hours, resident compliance was 58% on average. Conclusions: EHR use after hours constituted one-fifth of a vascular surgical trainee's total EHR time. Despite self-reported duty-hour compliance, a good proportion of their daily time is still spent on patient care. This pilot study sets the stage for larger studies to be conducted in future to address this issue.

Original languageEnglish (US)
Pages (from-to)1574-1579
Number of pages6
JournalJournal of Vascular Surgery
Volume69
Issue number5
DOIs
StatePublished - May 1 2019

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Electronic Health Records
Blood Vessels
Documentation
Compliance
Patient Care
Inventions
Tertiary Healthcare
Tertiary Care Centers
Medical Records
Observational Studies

All Science Journal Classification (ASJC) codes

  • Surgery
  • Cardiology and Cardiovascular Medicine

Cite this

@article{f75837be0b5e41aaaba0fc631f6db1a4,
title = "Vascular surgery residents spend one fifth of their time on electronic health records after duty hours",
abstract = "Objective: Electronic health records (EHR) have largely replaced paper-based medical records. Academic institutions have adapted EHR successfully and technological innovations now allow remote access. Thus, self-reported resident duty hours may not accurately reflect the actual time that is spent on patient care-related activities. Methods: This retrospective observational study quantified vascular surgery resident EHR activities between January 2016 and June 2016 at a tertiary care hospital. Use time was tracked from user login to logout, divided by day of the week, and separated by EHR tasks performed. Each 24-hour time period was further divided into on-duty (6:00 AM to 6:00 PM) and off-duty (6:00 PM to 6:00 AM) hours. On-call weekdays and rotations that occurred off campus were excluded. The following EHR activity data were requested: total time, chart review time, documentation time, electronic order entry, patient discovery, and electronic messages. Results: A total of 11,812 charts were accessed: 80.5{\%} on weekdays and 19.5{\%} on weekends. Total time spent (hours:minutes:seconds, weekday percentage, weekend percentage) on EHR during this time period was 634:33:36 (81.2{\%}, 18.8{\%}). On weekdays, 79{\%} of the EHR time was during the work hours and 21{\%} after hours. On weekends, 78{\%} of the EHR time was during work hours and 22{\%} after hours. Time spent on different EHR tasks was as follows: chart review 278:58:34, documentation 66:33:07, electronic order entry 120:50:24, electronic messaging 2:16:48, problem list modification 1:49:26, electronic messages 4:30:43, patient discovery 151:14:53, and other 164:05:17. Overall, postgraduate year 1 residents spent the most number of hours on EHRs and during the weekdays. There was serial decrease in the total number of EHR hours and the number of weekday hours with the seniority of the residents, with postgraduate year 5 residents spending the least number of overall hours and weekday hours on the EHR. When EHR access was compared with self-reported duty hours, resident compliance was 58{\%} on average. Conclusions: EHR use after hours constituted one-fifth of a vascular surgical trainee's total EHR time. Despite self-reported duty-hour compliance, a good proportion of their daily time is still spent on patient care. This pilot study sets the stage for larger studies to be conducted in future to address this issue.",
author = "Faisal Aziz and Lauren Talhelm and Jeremy Keefer and Conrad Krawiec",
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Vascular surgery residents spend one fifth of their time on electronic health records after duty hours. / Aziz, Faisal; Talhelm, Lauren; Keefer, Jeremy; Krawiec, Conrad.

In: Journal of Vascular Surgery, Vol. 69, No. 5, 01.05.2019, p. 1574-1579.

Research output: Contribution to journalArticle

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T1 - Vascular surgery residents spend one fifth of their time on electronic health records after duty hours

AU - Aziz, Faisal

AU - Talhelm, Lauren

AU - Keefer, Jeremy

AU - Krawiec, Conrad

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N2 - Objective: Electronic health records (EHR) have largely replaced paper-based medical records. Academic institutions have adapted EHR successfully and technological innovations now allow remote access. Thus, self-reported resident duty hours may not accurately reflect the actual time that is spent on patient care-related activities. Methods: This retrospective observational study quantified vascular surgery resident EHR activities between January 2016 and June 2016 at a tertiary care hospital. Use time was tracked from user login to logout, divided by day of the week, and separated by EHR tasks performed. Each 24-hour time period was further divided into on-duty (6:00 AM to 6:00 PM) and off-duty (6:00 PM to 6:00 AM) hours. On-call weekdays and rotations that occurred off campus were excluded. The following EHR activity data were requested: total time, chart review time, documentation time, electronic order entry, patient discovery, and electronic messages. Results: A total of 11,812 charts were accessed: 80.5% on weekdays and 19.5% on weekends. Total time spent (hours:minutes:seconds, weekday percentage, weekend percentage) on EHR during this time period was 634:33:36 (81.2%, 18.8%). On weekdays, 79% of the EHR time was during the work hours and 21% after hours. On weekends, 78% of the EHR time was during work hours and 22% after hours. Time spent on different EHR tasks was as follows: chart review 278:58:34, documentation 66:33:07, electronic order entry 120:50:24, electronic messaging 2:16:48, problem list modification 1:49:26, electronic messages 4:30:43, patient discovery 151:14:53, and other 164:05:17. Overall, postgraduate year 1 residents spent the most number of hours on EHRs and during the weekdays. There was serial decrease in the total number of EHR hours and the number of weekday hours with the seniority of the residents, with postgraduate year 5 residents spending the least number of overall hours and weekday hours on the EHR. When EHR access was compared with self-reported duty hours, resident compliance was 58% on average. Conclusions: EHR use after hours constituted one-fifth of a vascular surgical trainee's total EHR time. Despite self-reported duty-hour compliance, a good proportion of their daily time is still spent on patient care. This pilot study sets the stage for larger studies to be conducted in future to address this issue.

AB - Objective: Electronic health records (EHR) have largely replaced paper-based medical records. Academic institutions have adapted EHR successfully and technological innovations now allow remote access. Thus, self-reported resident duty hours may not accurately reflect the actual time that is spent on patient care-related activities. Methods: This retrospective observational study quantified vascular surgery resident EHR activities between January 2016 and June 2016 at a tertiary care hospital. Use time was tracked from user login to logout, divided by day of the week, and separated by EHR tasks performed. Each 24-hour time period was further divided into on-duty (6:00 AM to 6:00 PM) and off-duty (6:00 PM to 6:00 AM) hours. On-call weekdays and rotations that occurred off campus were excluded. The following EHR activity data were requested: total time, chart review time, documentation time, electronic order entry, patient discovery, and electronic messages. Results: A total of 11,812 charts were accessed: 80.5% on weekdays and 19.5% on weekends. Total time spent (hours:minutes:seconds, weekday percentage, weekend percentage) on EHR during this time period was 634:33:36 (81.2%, 18.8%). On weekdays, 79% of the EHR time was during the work hours and 21% after hours. On weekends, 78% of the EHR time was during work hours and 22% after hours. Time spent on different EHR tasks was as follows: chart review 278:58:34, documentation 66:33:07, electronic order entry 120:50:24, electronic messaging 2:16:48, problem list modification 1:49:26, electronic messages 4:30:43, patient discovery 151:14:53, and other 164:05:17. Overall, postgraduate year 1 residents spent the most number of hours on EHRs and during the weekdays. There was serial decrease in the total number of EHR hours and the number of weekday hours with the seniority of the residents, with postgraduate year 5 residents spending the least number of overall hours and weekday hours on the EHR. When EHR access was compared with self-reported duty hours, resident compliance was 58% on average. Conclusions: EHR use after hours constituted one-fifth of a vascular surgical trainee's total EHR time. Despite self-reported duty-hour compliance, a good proportion of their daily time is still spent on patient care. This pilot study sets the stage for larger studies to be conducted in future to address this issue.

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