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, Jeffrey E. Lee, Don O. Kikkawa, Christopher A. Longhurst, Michael Chiang, Michelle Hribar, Lucila Ohno-Machado

Research output: Contribution to journalArticle

Abstract

Purpose: To assess time requirements for patient encounters and estimate after-hours demands of paper-based clinical workflows in ophthalmology. Design: Time-and-motion study with a structured survey. Methods: This 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. Results: Among 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. Conclusions: Paper-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.

Original languageEnglish (US)
Pages (from-to)161-167
Number of pages7
JournalAmerican journal of ophthalmology
Volume206
DOIs
StatePublished - Oct 1 2019

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Workflow
Ophthalmology
Documentation
Time and Motion Studies
Electronic Health Records
Ambulatory Care Facilities
Patient Care
Ophthalmologists
Surveys and Questionnaires

ASJC Scopus subject areas

  • Ophthalmology

Cite this

Time Requirements of Paper-Based Clinical Workflows and After-Hours Documentation in a Multispecialty Academic Ophthalmology Practice. / Baxter, Sally L.; Gali, Helena E.; Huang, Abigail E.; Millen, Marlene; El-Kareh, Robert; Nudleman, Eric; Robbins, Shira L.; Heichel, Christopher W.D.; Camp, Andrew S.; Korn, Bobby S.; Lee, Jeffrey E.; Kikkawa, Don O.; Longhurst, Christopher A.; Chiang, Michael; Hribar, Michelle; Ohno-Machado, Lucila.

In: American journal of ophthalmology, Vol. 206, 01.10.2019, p. 161-167.

Research output: Contribution to journalArticle

Baxter, SL, Gali, HE, Huang, AE, Millen, M, El-Kareh, R, Nudleman, E, Robbins, SL, Heichel, CWD, Camp, AS, Korn, BS, Lee, JE, Kikkawa, DO, Longhurst, CA, Chiang, M, Hribar, M & Ohno-Machado, L 2019, 'Time Requirements of Paper-Based Clinical Workflows and After-Hours Documentation in a Multispecialty Academic Ophthalmology Practice', American journal of ophthalmology, vol. 206, pp. 161-167. https://doi.org/10.1016/j.ajo.2019.03.014
Baxter, Sally L. ; Gali, Helena E. ; Huang, Abigail E. ; Millen, Marlene ; El-Kareh, Robert ; Nudleman, Eric ; Robbins, Shira L. ; Heichel, Christopher W.D. ; Camp, Andrew S. ; Korn, Bobby S. ; Lee, Jeffrey E. ; Kikkawa, Don O. ; Longhurst, Christopher A. ; Chiang, Michael ; Hribar, Michelle ; Ohno-Machado, Lucila. / Time Requirements of Paper-Based Clinical Workflows and After-Hours Documentation in a Multispecialty Academic Ophthalmology Practice. In: American journal of ophthalmology. 2019 ; Vol. 206. pp. 161-167.
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abstract = "Purpose: To assess time requirements for patient encounters and estimate after-hours demands of paper-based clinical workflows in ophthalmology. Design: Time-and-motion study with a structured survey. Methods: This 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. Results: Among 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. Conclusions: Paper-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.",
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AU - Baxter, Sally L.

AU - Gali, Helena E.

AU - Huang, Abigail E.

AU - Millen, Marlene

AU - El-Kareh, Robert

AU - Nudleman, Eric

AU - Robbins, Shira L.

AU - Heichel, Christopher W.D.

AU - Camp, Andrew S.

AU - Korn, Bobby S.

AU - Lee, Jeffrey E.

AU - Kikkawa, Don O.

AU - Longhurst, Christopher A.

AU - Chiang, Michael

AU - Hribar, Michelle

AU - Ohno-Machado, Lucila

PY - 2019/10/1

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N2 - Purpose: To assess time requirements for patient encounters and estimate after-hours demands of paper-based clinical workflows in ophthalmology. Design: Time-and-motion study with a structured survey. Methods: This 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. Results: Among 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. Conclusions: Paper-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.

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