ArticleOphthalmology2019
Changes in Electronic Health Record Use Time and Documentation over the Course of a Decade.
Article in Ophthalmology, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 15 papers, 2 of them syntheses that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
15 citing papers in PubMed, 2 syntheses or guidelines pooled it.
- Measuring Documentation Burden in Healthcare.Journal of general internal medicine · 2024Pooled it
- Using electronic health record audit logs to study clinical activity: a systematic review of aims, measures, and methods.Journal of the American Medical Informatics Association : JAMIA · 2020Pooled it
- "Most of what I do is a workaround now": Clinician Use of Workarounds Following an EHR Transition.Journal of general internal medicine · 2026Article
- Optimizing Documentation Integrity of Ophthalmic Diagnostic Test Interpretation through Electronic Health Record Clinical Decision Support.Applied clinical informatics · 2025Article
- How Much More Time Neurologic Examination Adds to Outpatient Visits: A Study of Cross-Sectional Data.Neurology. Clinical practice · 2025Article
- Comparing ChatGPT and a Single Anesthesiologist's Responses to Common Patient Questions: An Exploratory Cross-Sectional Survey of a Panel of Anesthesiologists.Journal of medical systems · 2024Article
- Novel Note Templates to Enhance Signal and Reduce Noise in Medical Documentation: Prospective Improvement Study.JMIR formative research · 2023Article
- Early Performance of the Patients Over Paperwork Initiative among Family Medicine Physicians.Southern medical journal · 2023Article
- Measuring Collaboration Through Concurrent Electronic Health Record Usage: Network Analysis Study.JMIR medical informatics · 2021Article
- Length and Redundancy of Outpatient Progress Notes Across a Decade at an Academic Medical Center.JAMA network open · 2021Article
- Measurement of clinical documentation burden among physicians and nurses using electronic health records: a scoping review.Journal of the American Medical Informatics Association : JAMIA · 2021Article
- Electronic Health Records in Ophthalmology: Source and Method of Documentation.American journal of ophthalmology · 2020Article
- Methods for Large-Scale Quantitative Analysis of Scribe Impacts on Clinical Documentation.AMIA ... Annual Symposium proceedings. AMIA Symposium · 2020Article
- Influence of Scribes on Patient-Physician Communication in Primary Care Encounters: Mixed Methods Study.JMIR medical informatics · 2019Article
- Variations in Electronic Health Record-Based Definitions of Diabetic Retinopathy Cohorts: A Literature Review and Quantitative Analysis.Ophthalmology scienceArticle
Corrections and comments
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Authors and funding
6 authors.
Funding
Abstract
purposeWith the current wide adoption of electronic health records (EHRs) by ophthalmologists, there are widespread concerns about the amount of time spent using the EHR. The goal of this study was to examine how the amount of time spent using EHRs as well as related documentation behaviors changed 1 decade after EHR adoption.
designSingle-center cohort study.
participantsSix hundred eighty-five thousand three hundred sixty-one office visits with 70 ophthalmology providers.
methodsWe calculated time spent using the EHR associated with each individual office visit using EHR audit logs and determined chart closure times and progress note length from secondary EHR data. We tracked and modeled how these metrics changed from 2006 to 2016 with linear mixed models.
main outcome measuresMinutes spent using the EHR associated with an office visit, chart closure time in hours from the office visit check-in time, and progress note length in characters.
resultsMedian EHR time per office visit in 2006 was 4.2 minutes (interquartile range [IQR], 3.5 minutes), and increased to 6.4 minutes (IQR, 4.5 minutes) in 2016. Median chart closure time was 2.8 hours (IQR, 21.3 hours) in 2006 and decreased to 2.3 hours (IQR, 18.5 hours) in 2016. In 2006, median note length was 1530 characters (IQR, 1435 characters) and increased to 3838 characters (IQR, 2668.3 characters) in 2016. Linear mixed models found EHR time per office visit was 31.9±0.2% (P < 0.001) greater from 2014 through 2016 than from 2006 through 2010, chart closure time was 6.7±0.3 hours (P < 0.001) shorter from 2014 through 2016 versus 2006 through 2010, and note length was 1807.4±6.5 characters (P < 0.001) longer from 2014 through 2016 versus 2006 through 2010.
conclusionsAfter 1 decade of use, providers spend more time using the EHR for an office visit, generate longer notes, and close the chart faster. These changes are likely to represent increased time and documentation pressure for providers. Electronic health record redesign and new documentation regulations may help to address these issues.
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