This month, the print version of the Emergency Medicine Journal features an article from a group including Jeffrey Perry and Ian Stiell on a topic near and dear to our hearts – Electronic Health Records. While the next generation of physicians will never remember a time of charting on paper, the majority of practicing physicians recall such times – and many office-based practices may yet still use paper.
In the Emergency Department, however, one of our most valuable assets is time – and all such times are increasingly measured and under greater scrutiny as quality and efficiency metrics. With an eye towards this, Perry et al performed an observational, before-and-after, study comparing time spent in documentation on non-traumatic chest pain between paper charting and electronic charting. Paper charting required a mean of 6.1 minutes per patient, while electronic charting required 9.6 minutes. If one assumes this charting differential is generalizable to other complaints, and multiply such by a very reasonable 2 patients per-hour on an 8- or 9- hour shift – suddenly you’re looking at an additional hour of documentation time. Unsurprisingly, qualitative survey of clinicians found universal disfavor of electronic charting.
I shine a light on this article in the context of the ongoing American Medical Informatics Association Annual Meeting in Washington, DC (#AMIA14). If you spend any time perusing the social media or press releases from the meeting, all the hype is about “Big Data”, FHIR, and hackathons – advanced applications of clinical informatics, essentially, assuming an integrated Electronic Health Record infrastructure. What’s been utterly lost in the rush to the future are the basic considerations clinicians struggle with on a daily basis – carving out enough face-time with patients to deliver the best possible care. With initiatives such as “Meaningful Use” in the United States providing mandates for EHRs, the emphasis has clearly been on checking boxes for federal reimbursement – and hardly responsive to clinician concerns.
“Patient satisfaction” is an overwhelming industry mandate – what happened to clinician satisfaction?