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Review
. 2005 Sep-Oct;12(5):505-16.
doi: 10.1197/jamia.M1700. Epub 2005 May 19.

The impact of electronic health records on time efficiency of physicians and nurses: a systematic review

Lise Poissant  1 , Jennifer Pereira, Robyn Tamblyn, Yuko Kawasumi
Affiliations
Review

The impact of electronic health records on time efficiency of physicians and nurses: a systematic review

Lise Poissant et al. J Am Med Inform Assoc. 2005 Sep-Oct.

Abstract

A systematic review of the literature was performed to examine the impact of electronic health records (EHRs) on documentation time of physicians and nurses and to identify factors that may explain efficiency differences across studies. In total, 23 papers met our inclusion criteria; five were randomized controlled trials, six were posttest control studies, and 12 were one-group pretest-posttest designs. Most studies (58%) collected data using a time and motion methodology in comparison to work sampling (33%) and self-report/survey methods (8%). A weighted average approach was used to combine results from the studies. The use of bedside terminals and central station desktops saved nurses, respectively, 24.5% and 23.5% of their overall time spent documenting during a shift. Using bedside or point-of-care systems increased documentation time of physicians by 17.5%. In comparison, the use of central station desktops for computerized provider order entry (CPOE) was found to be inefficient, increasing the work time from 98.1% to 328.6% of physician's time per working shift (weighted average of CPOE-oriented studies, 238.4%). Studies that conducted their evaluation process relatively soon after implementation of the EHR tended to demonstrate a reduction in documentation time in comparison to the increases observed with those that had a longer time period between implementation and the evaluation process. This review highlighted that a goal of decreased documentation time in an EHR project is not likely to be realized. It also identified how the selection of bedside or central station desktop EHRs may influence documentation time for the two main user groups, physicians and nurses.

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Figures

Figure 1.
Figure 1.
Weighted relative time difference per patient attributed to the use of computers or personal digital assistant (PDA) among nurses and physicians studies.
Figure 2.
Figure 2.
Weighted relative time difference per working shifts attributed to the use of computers among nurse studies.
Figure 3.
Figure 3.
Reported relative time differences of the impact of computerized provider order entry (CPOE) use and weighted average of relative time differences across studies on CPOE.
Figure 4.
Figure 4.
Comparison of unweighted relative time differences among nurses by study decade. PDA = personal digital assistant.
Figure 5.
Figure 5.
Comparison of unweighted relative time differences among physicians by study decade. CPOE = computerized provider order entry; PDA = personal digital assistant.
See this image and copyright information in PMC

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