More than half of my ER shift was spent on entering data

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

  • 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.

“WhiteCoat” is an emergency physician who blogs at WhiteCoat’s Call Room at Emergency Physicians Monthly.

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  • http://twitter.com/sleeprestlive Patty Tucker

    No wonder it seems the costs of medical care are so high. We’re paying physicians $100 per hour for clerical work mandated by the insurance and legal industries!

  • http://www.facebook.com/people/Quanta-His-Kim/100003199486642 Quanta-His Kim

    May be some facts are true but now a days most of the software’s need not to more data entering work, there is automatic filling technique used.

  • Jane Berg

    Since the mandate and implementation of an EMR system in my own hospital, I’ve seen physician dissatisfaction increase and patient throughput decrease. Who is really gaining from this?

  • Beau Ellenbecker

    Not all EMR’s are horrible but most of the ones I have used, and unfortunately the one my company uses are really not well designed. Appears that to an EMR producer the chief function is to be able to calculate data and not convey the nature of a visit and plan for the future. I am using Centricity, only one week on it, but so far VERY unimpressed with it. Appears to have circa 1995 programming and numerous self limitations.

  • StephenModesto

    Thank you for sharing your experiences..It resonantes with a grimaced smile of irony to the many reading your post…computer freezes and watching `hourglasses’ only add to the aggravation of disrupted thought and focus. This `stuff, designed by hospitals and IT mainframe companies do not really have the front-line consult/input from the working `folks’ who are forced to use it because the administrators merely say a newer wheel in the cogs of the machine will now be implemented…because we have `bought’ it.

  • Docbart

    It seems that you have discovered that the EMR emperor has no clothes. Thank Newt Gingrich, for the “intellectual” inspiration to push this concept.
    Some ED docs appear to have “improved” throughput by template-driven or cloned notes and using such gems as “Meds: as per nurses notes”, “Plan: as per orders”. The notes are perfectly legible, but mostly content-free. Even better, this has facilitated upcoded billing, costing payers billions of dollars. That is the real driver behind EMR- profits for hardware and software vendors, increased billing by “provider” organizations. Productivity of individual physicians is not a consideration.