Electronic Health Record Usage in an Academic Orthopaedic Sports Medicine Practice

Abstract

Background While the relationship between electronic health record usage and physician burnout has been investigated in other specialties, no reports exist for orthopaedic surgery. The purpose of this study was to determine the amount of time spent on the electronic health record compared to actual patient interaction in four busy orthopaedic outpatient clinics. Hypothesis We hypothesized that surgeons would spend as much time on the electronic health record as they do interacting with patients on a typical clinic day. Methods Four busy academic orthopaedic surgeons (Surgeon 1, 2, 3, and 4) at a tertiary academic institution were each followed on clinic days to determine their total time spent on Epic Hyperspace electronic health record as compared to face-to-face interactions with patients. A research assistant recorded the amount of time each surgeon spent dictating notes, writing orders, or replying to clinical inbox messages (electronic health record time) and how much time was spent on loading screens or electronic health record buffering (loading time) during which no actions could be completed. Results Surgeon 1 spent an average of 63% of their clinic days using the electronic health record. Surgeon 2 spent 50% of their time on the computer. Surgeon 3 spent 35% of his days on the computer. Surgeon 4 spent 46% of his days on the computer. Conclusion Approximately half of each surgeon’s clinic time was spent using the electronic health record. Given the known influence of electronic health record usage on orthopaedic surgeon burnout, this is an issue that needs to be addressed. The solution likely involves a multifactorial approach, including changes to electronic health records, widespread use of scribes or advanced care teams, work hour limitations, and mindfulness training for residents and faculty. Information technology quality improvements can be made to EHRs that include reducing or eliminating unnecessary information displayed on screen, providing more abundant and accessible EHR training and on-site technical support, and a more streamlined software interface that eliminates unnecessary typing and clicks to improve charting flow and efficiency. Level of Evidence Level IV Descriptive Study