Evidence map›Paper›PMID 30910517›Full record

ArticleAmerican journal of ophthalmology2019

Time Requirements of Paper-Based Clinical Workflows and After-Hours Documentation in a Multispecialty Academic Ophthalmology Practice.

Sally L Baxter, Helena E Gali, Abigail E Huang, Marlene Millen, Robert El-Kareh, Eric Nudleman, Shira L Robbins, Christopher W D Heichel, Andrew S Camp, Bobby S Korn and 6 more

Abstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in American journal of ophthalmology, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 5 papers.

0numbers the graph read from it
0cells of the map it votes in
5citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

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.

2 · The registry

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.

3 · Its place in the literature

Who cites it

5 citing papers in PubMed.

  1. Article
  2. Review
  3. Article
  4. Article
  5. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

16 authors.

Sally L BaxterUniversity of California San Diego Shiley Eye Institute and Viterbi Family Department of Ophthalmology, La Jolla, California; Department of Biomedical Informatics, University of California San Diego, La Jolla, California. Electronic address: S1baxter@ucsd.edu.
Helena E GaliUniversity of California San Diego Shiley Eye Institute and Viterbi Family Department of Ophthalmology, La Jolla, California; Department of Biomedical Informatics, University of California San Diego, La Jolla, California.
Abigail E HuangDepartment of Medical Informatics and Clinical Epidemiology, Oregon Health and Science University, Portland, Oregon; Department of Ophthalmology, Casey Eye Institute, Oregon Health and Science University, Portland, Oregon.
Marlene MillenDepartment of Biomedical Informatics, University of California San Diego, La Jolla, California; Department of Medicine, University of California San Diego, La Jolla, California.
Robert El-KarehDepartment of Biomedical Informatics, University of California San Diego, La Jolla, California; Department of Medicine, University of California San Diego, La Jolla, California.
Eric NudlemanUniversity of California San Diego Shiley Eye Institute and Viterbi Family Department of Ophthalmology, La Jolla, California.
Shira L RobbinsUniversity of California San Diego Shiley Eye Institute and Viterbi Family Department of Ophthalmology, La Jolla, California.
Christopher W D HeichelUniversity of California San Diego Shiley Eye Institute and Viterbi Family Department of Ophthalmology, La Jolla, California.
Andrew S CampUniversity of California San Diego Shiley Eye Institute and Viterbi Family Department of Ophthalmology, La Jolla, California.
Bobby S KornUniversity of California San Diego Shiley Eye Institute and Viterbi Family Department of Ophthalmology, La Jolla, California.
Jeffrey E LeeUniversity of California San Diego Shiley Eye Institute and Viterbi Family Department of Ophthalmology, La Jolla, California.
Don O KikkawaUniversity of California San Diego Shiley Eye Institute and Viterbi Family Department of Ophthalmology, La Jolla, California.
Christopher A LonghurstDepartment of Biomedical Informatics, University of California San Diego, La Jolla, California.
Michael F ChiangDepartment of Medical Informatics and Clinical Epidemiology, Oregon Health and Science University, Portland, Oregon; Department of Ophthalmology, Casey Eye Institute, Oregon Health and Science University, Portland, Oregon.
Michelle R HribarDepartment of Medical Informatics and Clinical Epidemiology, Oregon Health and Science University, Portland, Oregon; Department of Ophthalmology, Casey Eye Institute, Oregon Health and Science University, Portland, Oregon.
Lucila Ohno-MachadoDepartment of Biomedical Informatics, University of California San Diego, La Jolla, California; Department of Medicine, University of California San Diego, La Jolla, California; Division of Health Services Research and Development, Veterans Administration San Diego Healthcare System, La Jolla, California.

Funding

UC San Diego Clinical and Translational Research InstituteUL1TR001442 · NCATS · UNIVERSITY OF CALIFORNIA, SAN DIEGO · PI FIRESTEIN, GARY S, HOGARTH, MICHAEL · 2015 to 2024
$88.3M
Proteomics CoreP30EY010572 · NEI · OREGON HEALTH & SCIENCE UNIVERSITY · PI TED S ACOTT · 1995 to 2026
$19.4M
SAN DIEGO CLINICAL AND TRANSLATIONAL RESEARCH INSTITUTEUL1RR031980 · NCRR · UNIVERSITY OF CALIFORNIA, SAN DIEGO · PI FIRESTEIN, GARY S · 2010 to 2011
$14.0M
Vision BiostatisticsP30EY022589 · NEI · UNIVERSITY OF CALIFORNIA, SAN DIEGO · PI Derek Stuart Welsbie · 2012 to 2026
$10.3M
San Diego Biomedical Informatics Education & Research (SABER)T15LM011271 · NLM · UNIVERSITY OF CALIFORNIA, SAN DIEGO · PI SHAMIM NEMATI · 2012 to 2026
$9.7M
Modeling and Optimization of Clinical Processes Using EHR DataR00LM012238 · NLM · OREGON HEALTH & SCIENCE UNIVERSITY · PI HRIBAR, MICHELLE · 2017 to 2019
$672k
NCATS NIH HHS UL1 TR001442NCRR NIH HHS UL1 RR031980NEI NIH HHS P30 EY010572NEI NIH HHS P30 EY022589NLM NIH HHS R00 LM012238NLM NIH HHS T15 LM011271
6 · The paper itself

Abstract

purposeTo assess time requirements for patient encounters and estimate after-hours demands of paper-based clinical workflows in ophthalmology.

designTime-and-motion study with a structured survey.

methodsThis study was conducted in a single academic ophthalmology department. A convenience sample consisted of 7 attending ophthalmologists from 6 subspecialties observed during 414 patient encounters for the time-motion analysis and 12 attending ophthalmologists for the survey. Outcome measurements consisted of total time spent by attending ophthalmologists per patient and time spent on documentation, examination, and talking with patients. The survey assessed time requirements of documentation-related activities performed outside of scheduled clinic hours.

resultsAmong the 7 attending ophthalmologists observed (6 men and 1 woman), mean ± SD age 43.9 ± 7.1 years, during encounters with 414 patients (57.8 ± 24.6 years of age), total time spent per patient was 8.1 ± 4.8 minutes, with 2.8 ± 1.4 minutes (38%) for documentation, 1.2 ± 0.9 minutes (17%) for examination, and 3.3 ± 3.1 minutes (37%) for talking with patients. New patient evaluations required significantly more time than routine follow-up visits and postoperative visits. Higher clinical volumes were associated with less time per patient. Survey results indicated that paper-based documentation was associated with minimal after-hours work on weeknights and weekends.

conclusionsPaper-based documentation takes up a substantial portion of the total time spent for patient care in outpatient ophthalmology clinics but is associated with minimal after-hours work. Understanding paper-based clinical workflows may help inform targeted strategies for improving electronic health record use in ophthalmology.

Indexed as

Academic Medical CentersWorkflowAdolescentAdultAgedAged, 80 and overChildChild, PreschoolDocumentationElectronic Health RecordsFemaleHumansInfantInfant, NewbornMaleMiddle Aged

Identifiers

PMID30910517
PMCPMC6755078

What OpenQuestion holds

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.