SAN DIEGO – Family medicine residents reported that documentation time increased by about 16 minutes per patient encounter following implementation of an electronic health record system at two academic medical institutions in Southern California.
"We have learned about how electronic health records are going to improve our patient care and our efficiency in the clinic but not a lot of studies have explored how the implementation of an electronic health record at academic centers is going to impact resident education," Dr. Maisara Rahman said in an interview during a poster session at the annual meeting of the American Academy of Family Physicians.
Dr. Maisara Rahman
Dr. Rahman and her associates surveyed 122 family medicine residents, attending physicians, and other clinical staff from Riverside County Regional Medical Center (RCRMC) and Pomona Valley Hospital Medical Center (PVHMC) to assess their perceptions about the adequacy of EHR training, the amount of time spent on documentation, and the effects of EHRs on patient care and resident education. Of the 122 people surveyed, 99 responded, for a response rate of 83%.
Dr. Rahman, in the department of family medicine at Loma Linda University and an attending physician in the department of family medicine at RCRMC, reported that there was an overall decrease in resident productivity at both academic institutions following implementation of the EHR: a 30% decrease at RCRMC and a 20% decrease at PVHMC. Overall, respondents indicated that EHR documentation took about 16 minutes longer to complete compared with documentation by paper chart (an average of 37 vs. 21 minutes, respectively.)
The residents also reported missing an average of two educational didactic lecture sessions per month in order to complete EHR notes. In addition to missing didactic lectures, residents from both institutions used an average of 45 minutes of personal time to complete notes for a typical half-day clinic. "That’s pretty significant," Dr. Rahman said. "Resident satisfaction with EHR implementation was highly correlated with whether the respondents had adequate EHR training. When we compared the residents from the two academic sites, we noticed that a lot of the RCRMC residents were not satisfied and were not happy with the system. They were less efficient and less productive in clinic, and it was correlated to the training hours. This is most likely related to RCRMC being a county facility and there are fewer resources to provide adequate EHR training for residents."
In their poster, the researchers concluded that as academic teaching hospitals implement EHRs to meet financial incentives for meaningful use, "it is imperative that these institutions customize and implement EHR systems that enhance and support resident education. EHR has a unique potential to become an educational tool if it is customized and developed for resident education. The traditional teaching methods in ambulatory clinics will need to adapt to a more innovative, technology-enhanced learning environment. Further research is needed to identify improved EHR systems that optimize and enhance residents’ education."
The researchers stated that they had no relevant financial conflicts to disclose.