Abstract
BackgroundDespite the many benefits of electronic health records (EHRs), studies have reported that EHR implementation could create unintended changes in the workflow if not studied and designed properly. These changes may impact the time patients spend on the various steps of their visits, such as the time spent in the waiting area and with a physician. The amount of time patients spend in the waiting area before consultation is often a strong predictor of patient satisfaction, willingness to come back for a return visit, and overall experience. The majority of prior studies that examined the impact of EHR systems on time focused on single aspects of patient visits or user (physicians or nurses) activities. The impact of EHR use on patients’ time spent during the different aspects of the visit is rarely investigated.ObjectiveThis study aimed to evaluate the impact of EHR systems on the amount of time spent by patients on different tasks during their visit to primary health care (PHC) centers.MethodsA time and motion observational study was conducted at 4 PHC centers. The PHC centers were selected using stratified randomized sampling. Of the 4 PHC centers, 2 used an EHR system and 2 used a paper-based system. Each group had 1 center in a metropolitan area and another in a rural area. In addition, a longitudinal observation was conducted at one of the PHC centers after 1 year and again after 2 years of implementation. The analysis included descriptive statistics and group comparisons.ResultsThe results showed no significant difference in the amount of time spent by patients in the reception area (P=.26), in the waiting area (P=.57), consultation time (P=.08), and at the pharmacy (P=.28) between the EHR and paper based groups. However, there was a significant difference (P<.001) in the amount of time spent on all tasks between the PHC centers located in metropolitan and rural areas. The longitudinal observation also showed reduction in the registration time (from 5.5 [SD 3.5] min to 0.9 [SD 0.5] min), which could be attributed to the introduction of a Web-based booking system.ConclusionsThe variation in the time patients spend at PHC centers is more likely to be attributed to the facility location than EHR use. The changes in the introduction of new tools and functions, however, such as the Web-based booking system, can impact the duration of patients’ visits.
Highlights
Many studies have shown the benefits of electronic health records (EHRs) in reducing duplicate tests and procedures, reducing drug expenditures, improving the utilization of radiology tests, allowing for better documentation of charges, and decreasing billing errors [1,2,3,4,5,6]
The variation in the time patients spend at primary health care (PHC) centers is more likely to be attributed to the facility location than EHR use
No significant differences were found between PHC centers that used an EHR-based system and those that used a paper-based system (P=.26, P=.57, P=.08, and P=.28 for the reception time, waiting time, consultation time, and time spent at the pharmacy, respectively; Table 1 and Figure 1)
Summary
Many studies have shown the benefits of electronic health records (EHRs) in reducing duplicate tests and procedures, reducing drug expenditures, improving the utilization of radiology tests, allowing for better documentation of charges, and decreasing billing errors [1,2,3,4,5,6]. Agency for Healthcare Research and Quality defined workflow as “a sequence of physical and mental tasks performed by various people within and between work environments. Despite the many benefits of electronic health records (EHRs), studies have reported that EHR implementation could create unintended changes in the workflow if not studied and designed properly. These changes may impact the time patients spend on the various steps of their visits, such as the time spent in the waiting area and with a physician. The majority of prior studies that examined the impact of EHR systems on time focused on single aspects of patient visits or user (physicians or nurses) activities. The impact of EHR use on patients’ time spent during the different aspects of the visit is rarely investigated
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