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First published June 28, 2007 as JAMIA PrePrint; doi:10.1197/jamia.M2318
Journal of the American Medical Informatics Association 2007;14(5):609-615
© 2007 American Medical Informatics Association

A more recent version of this article appeared on September 1, 2007
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Submitted on November 2, 2006
Accepted on May 20, 2007

Electronic Health Records in Specialty Care: A Time-Motion Study

Helen G. Lo1, Lisa P. Newmark1, Catherine Yoon MS2, Lynn A. Volk MHS1, Virginia L. Carlson3, Anne F. Kittler1, Margaret Lippincott3, Tiffany Wang3, and David W. Bates MD, MSc4*

Affiliation of the authors: 1 Information Systems, Partners HealthCare System, Wellesley, MA; 2 MS, Division of General Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA ; 3 Division of General Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA ; 4 Information Systems, Partners HealthCare System, Wellesley, MA; Division of General Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA; Harvard School of Public Health, Boston, MA; Harvard Medical School, Boston, MA

* To whom correspondence should be addressed.

Background Electronic health records (EHRs) have great potential to improve safety, quality, and efficiency in medicine. However, adoption has been slow, and a key concern has been that clinicians will require more time to complete their work using EHRs. Most previous studies addressing this issue have been done in primary care.

Objective To assess the impact of using an EHR on specialists' time.

Design Prospective, before-after trial of the impact of an EHR on attending physician time in four specialty clinics at an integrated delivery system: cardiology, dermatology, endocrine, and pain.

Measuerments We used a time-motion method to measure physician time spent in one of 85 designated activities.

Results Attending physicians were monitored before and after the switch from paper records to a web-based ambulatory EHR. Across all specialties, 15 physicians were observed treating 157 patients while still using paper-based records, and 15 physicians were observed treating 146 patients after adoption. Following EHR implementation, the average adjusted total time spent per patient across all specialties increased slightly but not significantly ({Delta}=0.94 min., p=0.83) from 28.8 (SE=3.6) to 29.8 (SE=3.6) min.

Conclusion These data suggest that implementation of an EHR had little effect on overall visit time in specialty clinics.






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