A study published in JAMIA found that a restricted EHR configuration limiting clinicians to one patient record at a time did not affect clinician efficiency, despite the belief that an unrestricted EHR was more efficient. The study supports the use of an unrestricted EHR configuration as safe and clinician-centered. However, clinicians in the restricted format reported frustration at their inability to multitask, leading to potentially hazardous EHR workarounds. The study measured efficiency using total active minutes per day and was a substudy of a larger randomized controlled trial.
The implementation of electronic health record (EHR) systems has transformed the healthcare industry in several ways, including making it easier for clinicians to access patient information and improving care coordination. However, the use of EHRs also presents challenges, such as the risk of wrong-patient errors and the potential for information overload, which can negatively impact clinician efficiency and patient outcomes.
One potential solution to these challenges is to restrict EHR configurations to limit the number of patient records that can be opened at any given time. However, a recent study published in the Journal of the American Medical Informatics Association (JAMIA) suggests that this may not be the best approach. The study found that a restricted EHR configuration, limited to one patient record open at a time, did not impact clinician efficiency, despite perceptions that an unrestricted EHR was more efficient.
Background
The study was a substudy of a larger randomized controlled trial (RCT) that compared the impact of restricted and unrestricted EHR configurations on wrong-patient errors. The primary outcome of the parent study was the rate of wrong-patient errors, while the substudy focused on clinician efficiency.
In the parent study, clinicians were randomized to one of two EHR configurations: a restricted configuration, which allowed only one patient record to be open at a time, or an unrestricted configuration, which allowed up to four patient records to be open concurrently. The study found no significant difference in wrong-patient errors between the two groups.
The study analyzed data from 2,556 clinicians who participated in the parent study to compare the efficiency of the two EHR configurations. The study measured efficiency using total active minutes per day, which included time spent reviewing patient charts, entering orders, and communicating with patients and other healthcare providers.
Results
The study found no significant difference between the unrestricted and restricted groups in total active minutes per day overall or by clinician type and practice area. Despite no difference in efficiency measures, the study participants reported greater efficiency in the unrestricted configuration. Clinicians in the restricted format reported frustrations at their inability to multitask, which prompted some to use potentially hazardous EHR workarounds.
“Therefore, although the unrestricted configuration was perceived as more efficient by clinicians, perhaps owing to the ability to open multiple records as needed, these results suggest no savings in time or effort on average based on EHR audit log metrics,” the study authors wrote.
The study’s findings support an unrestricted EHR configuration being as safe as a restricted configuration while being more clinician-centered.
Strengths and Limitations
The authors noted that the study has several strengths. “First, clinicians were randomized to the different EHR configurations,” they wrote. “Second, many clinicians in different roles and settings were included and analyzed in this study.”
However, the study also has multiple limitations. First, it was a substudy of a larger RCT and not the primary outcome of the parent study. Second, the researchers conducted the study in a single-center setting, potentially limiting generalizability. Lastly, using total active minutes as a measure of efficiency captures just one dimension of a complex construct, the researchers pointed out.
“Measuring clinician efficiency involves many factors, including quantifying specific tasks in patient care and tasks completed per unit of time,” they wrote. “There may be unmeasured factors that explain clinicians’ perception of greater efficiency in the unrestricted arm in the parent RCT.” However, “total active minutes have been proposed as the key metric to measure clinician efficiency.”
