This Article Full Text Full Text (PDF) All Versions of this Article: M1700v1 12/5/505    most recent Submit a response Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Poissant, L. Articles by Kawasumi, Y. Search for Related Content PubMed PubMed Citation Articles by Poissant, L. Articles by Kawasumi, Y.

The Impact of Electronic Health Records on Time Efficiency of Physicians and Nurses: A Systematic Review

Affiliations of the authors: Clinical and Health Informatics (LP), Medicine and Clinical Epidemiology (RT), and Departments of Epidemiology and Biostatistics (RT, YK), McGill University, Montreal, Quebec, Canada; Department of Pharmaceutical Sciences, University of Toronto and Centre for Evaluation of Medicines, St. Joseph's Healthcare, Toronto, Ontario, Canada (JP).

Correspondence and reprints: Lise Poissant, PhD, Clinical and Health Informatics Research Group, McGill University, Morrice House, 1140 Pine Ave. West, Montreal Quebec, Canada H3A 1A3; e-mail: <lise.poissant{at}mcgill.ca>.

Received for publication: 09/16/04; accepted for publication: 04/24/05.

A systematic review of the literature was performed to examine the impact of electronic health records (EHRs) on documentation time of physicians and nurses and to identify factors that may explain efficiency differences across studies. In total, 23 papers met our inclusion criteria; five were randomized controlled trials, six were posttest control studies, and 12 were one-group pretest-posttest designs. Most studies (58%) collected data using a time and motion methodology in comparison to work sampling (33%) and self-report/survey methods (8%). A weighted average approach was used to combine results from the studies. The use of bedside terminals and central station desktops saved nurses, respectively, 24.5% and 23.5% of their overall time spent documenting during a shift. Using bedside or point-of-care systems increased documentation time of physicians by 17.5%. In comparison, the use of central station desktops for computerized provider order entry (CPOE) was found to be inefficient, increasing the work time from 98.1% to 328.6% of physician's time per working shift (weighted average of CPOE-oriented studies, 238.4%). Studies that conducted their evaluation process relatively soon after implementation of the EHR tended to demonstrate a reduction in documentation time in comparison to the increases observed with those that had a longer time period between implementation and the evaluation process. This review highlighted that a goal of decreased documentation time in an EHR project is not likely to be realized. It also identified how the selection of bedside or central station desktop EHRs may influence documentation time for the two main user groups, physicians and nurses.

This article has been cited by other articles:

				P. D. Stetson, F. P. Morrison, S. Bakken, S. B. Johnson, and eNote Research Team Preliminary Development of the Physician Documentation Quality Instrument J. Am. Med. Inform. Assoc., July 1, 2008; 15(4): 534 - 541. [Abstract] [Full Text] [PDF]

				G. J.M. Tevaarwerk MD Electronic medical records Can. Med. Assoc. J., May 6, 2008; 178(10): 1323 - 1323. [Full Text] [PDF]

				S. B. Johnson, S. Bakken, D. Dine, S. Hyun, E. Mendonca, F. Morrison, T. Bright, T. Van Vleck, J. Wrenn, and P. Stetson An Electronic Health Record Based on Structured Narrative J. Am. Med. Inform. Assoc., January 1, 2008; 15(1): 54 - 64. [Abstract] [Full Text] [PDF]

				W. Hollingworth, E. B. Devine, R. N. Hansen, N. M. Lawless, B. A. Comstock, J. L. Wilson-Norton, K. L. Tharp, and S. D. Sullivan The Impact of e-Prescribing on Prescriber and Staff Time in Ambulatory Care Clinics: A Time Motion Study J. Am. Med. Inform. Assoc., November 1, 2007; 14(6): 722 - 730. [Abstract] [Full Text] [PDF]

				J. I. Westbrook, J. Braithwaite, A. Georgiou, A. Ampt, N. Creswick, E. Coiera, and R. Iedema Multimethod Evaluation of Information and Communication Technologies in Health in the Context of Wicked Problems and Sociotechnical Theory J. Am. Med. Inform. Assoc., November 1, 2007; 14(6): 746 - 755. [Abstract] [Full Text] [PDF]

				H. G. Lo, L. P. Newmark, C. Yoon, L. A. Volk, V. L. Carlson, A. F. Kittler, M. Lippincott, T. Wang, and D. W. Bates Electronic Health Records in Specialty Care: A Time-Motion Study J. Am. Med. Inform. Assoc., September 1, 2007; 14(5): 609 - 615. [Abstract] [Full Text] [PDF]

				B. D. Franklin, K. O'Grady, P. Donyai, A. Jacklin, and N. Barber The impact of a closed-loop electronic prescribing and administration system on prescribing errors, administration errors and staff time: a before-and-after study Qual. Saf. Health Care, August 1, 2007; 16(4): 279 - 284. [Abstract] [Full Text] [PDF]

				S. M. Handler, R. L. Altman, S. Perera, J. T. Hanlon, S. A. Studenski, J. E. Bost, M. I. Saul, and D. B. Fridsma A Systematic Review of the Performance Characteristics of Clinical Event Monitor Signals Used to Detect Adverse Drug Events in the Hospital Setting J. Am. Med. Inform. Assoc., July 1, 2007; 14(4): 451 - 458. [Abstract] [Full Text] [PDF]

				J.-T. Lium, H. Laerum, T. Schulz, and A. Faxvaag From the Front Line, Report from a Near Paperless Hospital: Mixed Reception Among Health Care Professionals J. Am. Med. Inform. Assoc., November 1, 2006; 13(6): 668 - 675. [Abstract] [Full Text] [PDF]

				C. P. Schade, F. M. Sullivan, S. de Lusignan, and J. Madeley e-Prescribing, Efficiency, Quality: Lessons from the Computerization of UK Family Practice J. Am. Med. Inform. Assoc., September 1, 2006; 13(5): 470 - 475. [Abstract] [Full Text] [PDF]

				E. M. Campbell, D. F. Sittig, J. S. Ash, K. P. Guappone, and R. H. Dykstra Types of Unintended Consequences Related to Computerized Provider Order Entry J. Am. Med. Inform. Assoc., September 1, 2006; 13(5): 547 - 556. [Abstract] [Full Text] [PDF]

				D. F. Sittig, J. S. Ash, J. Zhang, J. A. Osheroff, and M. M. Shabot Lessons From "Unexpected Increased Mortality After Implementation of a Commercially Sold Computerized Physician Order Entry System" Pediatrics, August 1, 2006; 118(2): 797 - 801. [Full Text] [PDF]

				J. Keen The NHS programme for information technology BMJ, July 1, 2006; 333(7557): 3 - 4. [Full Text] [PDF]

				J. Sidorov It Ain't Necessarily So: The Electronic Health Record And The Unlikely Prospect Of Reducing Health Care Costs. Health Aff., July 1, 2006; 25(4): 1079 - 1085. [Abstract] [Full Text] [PDF]

				W. F. Bria II Applied Medical Informatics for the Chest Physician: Information You Can USE!--Part 2 Chest, March 1, 2006; 129(3): 777 - 782. [Abstract] [Full Text] [PDF]