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First published May 19, 2005 as JAMIA PrePrint; doi:10.1197/jamia.M1700
Journal of the American Medical Informatics Association 2005;12(5):505-516
© 2005 American Medical Informatics Association

A more recent version of this article appeared on September 1, 2005
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Submitted on September 16, 2004
Accepted on April 24, 2005

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

Lise Poissant PhD1*, Jennifer Pereira MSc2, Robyn Tamblyn PhD3, and Yuko Kawasumi MSc4

Affiliation of the authors: 1 Clinical and Health Informatics, McGill University, Montreal, Canada; 2 Department of Pharmaceutical Sciences, University of Toronto, Toronto, Canada; Centre for Evaluation of Medicines, St. Joseph's Healthcare; 3 Medicine and Clinical Epidemiology, McGill University, Montreal, Canada; Departments of Epidemiology and Biostatistics, McGill University, Montreal, Canada; 4 Departments of Epidemiology and Biostatistics, McGill University, Montreal, Canada

* To whom correspondence should be addressed.

A systematic review of the literature was performed to examine the impact of electronic health records (EHR) 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 RCTs, six were posttest-control studies and twelve 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 physician 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.




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