Monday, September 30, 2013

Death From a Thousand Clicks

The modern physician – one of the most highly-skilled, highly-compensated data-entry technicians in history.

This is a prospective, observational evaluation of physician activity in the Emergency Department, focusing mostly the time spent in interaction with the electronic health record.  Specifically, they counted mouse clicks during various documentation, order-entry, and other patient care activities.  The observations were conducted for 60-minute time periods, and then extrapolated out to an entire shift, based on multiple observations.

The observations were taken from a mix of residents, attendings, and physician extenders, and offer a lovely glimpse into the burdensome overhead of modern medicine: 28% of time was spent in patient contact, while 44% was spent performing data-entry tasks.  It requires 6 clicks to order an aspirin, 47 clicks to document a physical examination of back pain, and 187 clicks to complete an entire patient encounter for an admitted patient with chest pain.  This extrapolates out, at a pace of 2.5 patients per hour, to ~4000 clicks for a 10-hour shift.

The authors propose a more efficient documentation system would result in increased time available for patient care, increased patients per hour, and increased RVUs per hour.  While the numbers they generate from this sensitivity analysis for productivity increase are essentially fantastical, the underlying concept is valid: the value proposition for these expensive, inefficient electronic health records is based on maximizing reimbursement and charge capture, not by empowering providers to become more productive.

The EHR in use in this study is McKesson Horizon – but, I'm sure these results are generalizable to most EHRs in use today.

"4000 Clicks: a productivity analysis of electronic medical records in a community hospital ED"
http://www.ncbi.nlm.nih.gov/pubmed/24060331

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