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The Impact of Electronic Health Records on the Duration of Patients’ Visits: Time and Motion Study

机译：电子健康记录对患者访问期间的影响：时间和运动研究

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Background Despite the many benefits of electronic health records (EHRs), studies have reported that EHR implementation could create unintended changes in the workflow if not studied and designed properly. These changes may impact the time patients spend on the various steps of their visits, such as the time spent in the waiting area and with a physician. The amount of time patients spend in the waiting area before consultation is often a strong predictor of patient satisfaction, willingness to come back for a return visit, and overall experience. The majority of prior studies that examined the impact of EHR systems on time focused on single aspects of patient visits or user (physicians or nurses) activities. The impact of EHR use on patients’ time spent during the different aspects of the visit is rarely investigated. Objective This study aimed to evaluate the impact of EHR systems on the amount of time spent by patients on different tasks during their visit to primary health care (PHC) centers. Methods A time and motion observational study was conducted at 4 PHC centers. The PHC centers were selected using stratified randomized sampling. Of the 4 PHC centers, 2 used an EHR system and 2 used a paper-based system. Each group had 1 center in a metropolitan area and another in a rural area. In addition, a longitudinal observation was conducted at one of the PHC centers after 1 year and again after 2 years of implementation. The analysis included descriptive statistics and group comparisons. Results The results showed no significant difference in the amount of time spent by patients in the reception area ( P =.26), in the waiting area ( P =.57), consultation time ( P =.08), and at the pharmacy ( P =.28) between the EHR and paper based groups. However, there was a significant difference ( P .001) in the amount of time spent on all tasks between the PHC centers located in metropolitan and rural areas. The longitudinal observation also showed reduction in the registration time (from 5.5 [SD 3.5] min to 0.9 [SD 0.5] min), which could be attributed to the introduction of a Web-based booking system. Conclusions The variation in the time patients spend at PHC centers is more likely to be attributed to the facility location than EHR use. The changes in the introduction of new tools and functions, however, such as the Web-based booking system, can impact the duration of patients’ visits.
机译：背景，尽管电子健康记录（EHRS）的许多好处，但研究报告说，如果没有正确研究和设计，EHR实施可能会产生非预期的变化。这些变化可能会影响时间患者在其访问中的各个步骤上花费，例如在等候区和医生的时间。咨询前患者在候诊区花费的时间往往是患者满意度的强大预测因素，愿意回到回访，以及整体经验。大多数事先研究检查了EHR系统按时的影响，专注于患者访问或用户（医生或护士）活动的单一方面。 EHR使用对参观不同方面的患者时间的影响很少被调查。目的本研究旨在评估EHR系统对患者在不同任务的时间内花费的影响，在他们访问初级医疗保健（PHC）中心。方法在4个PHC中心进行时间和运动观察研究。使用分层随机抽样选择PHC中心。在4个PHC中心中，2使用EHR系统和2使用了基于纸的系统。每组在大都市地区和另一个在农村地区的一个中心。此外，在2年后再次在1年后在1年后进行纵向观察。分析包括描述性统计和组比较。结果结果表明，在接收区（P = .26）中，在等候区（P = .57），咨询时间（P = .08）和药房，患者在接收区（P = .26）所花费的时间没有显着差异（P = .28）EHR和纸张组之间的组。然而，在位于大都市和农村地区的PHC中心之间的所有任务所花费的时间内存在显着差异（P <.001）。纵向观察还显示了登记时间的降低（从5.5 [SD 3.5] min至0.9 [SD 0.5]），这可能归因于引入基于网络的预订系统。结论在PHC中心支出的时间患者的变化更可能归因于该设施位置而不是EHR使用。然而，引入新工具和功能的变化，例如基于网络的预订系统，可能会影响患者访问的持续时间。

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