The impact of electronic patient records on workflow in general practice

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This is a review of Cauldwell, M., Beattie, C., Cox, B., Denby, W., Ede-Golightly, J., Linton, F's 2007 article, The impact of electronic patient records on workflow in general practice. [1]

Review 1

Patients Access to Electronic Healthcare Records Systems (PAERS) was developed in response to recent legislation in the NHS facilitating electronic access to healthcare records. Much of the published literature describes the potential clinical and administrative benefits of electronic patient records (EPR) but recognizes the need to specifically address the potential impact of EPR on workflow by providing “clear evidence of timesaving and improved service delivery”.

Objective

To identify the impact of PAERS on patient registration time and clinical consultation time.

Methods

Questionnaires were completed at both sites.

The authors utilized quantitative measurements of the length of time taken by patients to register at two surgery practices with similar patient demographics. The South Lewisham Group Practice utilized a manual process. The Wells Park Practice utilized both the PAERS system as well as a manual process.

Quantitative measures of the total consultation time were assessed at both practices.

Structured interviews were conducted to explore whether each group perceived a change in workflow arising from the introduction (or potential introduction) of PAERS.


Main Results

Patient Questionnaires

Average length of consultative time: 11.5 mins pre-PAERS; 10.11 mins post-PAERS.

Opinion on whether viewing e-notes had affected length of consultation time: reduced 77.8%; No impact 11.1%.

Opinion on whether viewing e-notes would impact length of consultation time: 80.2% believed would reduce.

Would PAERS make the consultative process more efficient? 90% concurred.

Practitioner Questionnaires

For Wells Park, the proportion of time spent explaining results/reports pre-PAERS and post-PAERS was 23.3% and 19.3%, respectively; for Lewisham it was 24.2% without PAERS but 36.3% if PAERS were to be implemented.

For Wells Park, the proportion of time spent correcting inaccuracies pre-PAERS and post-PAERS was 8.5% and 6.5%, respectively; for Lewisham it was 7.1% without PAERS but 14.2% if PAERS were to be implemented.

For Wells Park, the proportion of time spent explaining written notes pre-PAERS and post-PAERS was 16.1% and 11.5%, pespectively; for Lewisham it was 7.1% without PAERS but 16.7% if PAERS were to be implemented.


Administrative Staff Questionnaires

Actual or perceived reduction of time spent registering patients: 100% actual at Wells Park; 100% perceived at Lewisham.

Actual or perceived reduction in time spent dealing with appointments 75% actual at Wells Park; 100% perceived at Lewisham.

Conclusions

Albeit a small study, the authors provide indications of a positive impact of an EPR on workflow. Although the authors express concern with regard to low utilization of PAERS by patients, they do recommend adoption of PAERS as a means of improving efficiency provided that there is support for and encouragement of use amongst patients.

Commentary

The authors are able to show a quantitative benefit with regard to specific workflow metrics as a consequence of the implementation of an electronic patient record system.

This was a very small study with only 120 questionnaires completed at two similar clinical sites (both were surgery centers). It is difficult to generalize the scalability of this study with regard to potential improvements in efficiencies given the diversity of clinical settings (i.e. non-surgical vs. surgical), patient populations, and patient IT literacy in actual existence.

Interestingly, the authors comment that the number of registered “regular” users of the PAERS was quite small (10.32%). It is unclear if the theoretical cost savings the authors calculated included the extra administrative support necessary to encourage a larger percentage of patients to adopt and regularly use the system.

Finally, it is interesting that the opinions of the practitioners at the site which did not utilize PAERS reflected the perception that its implementation would result in decreased efficiencies. Although the authors do not suggest a reason, it may indicate a general degree of angst amongst practitioners with regard to the introduction of new and unfamiliar technologies into their daily workflows.


Review 2

This paper is a case report with one study site and one control site. It describes the introduction of a point of care personal health record (PHR) functionality of an EMR. The name of this program is Patient Access to Electronic Healthcare Records System (PAERS). This paper also assesses the impact before and after as well as a comparison to an office practice that does not have such a PHR. In particular the study examines patient registration time and clinical consultation time. The setting for the intervention is a single General practitioner outpatient office in the UK in which 53 patients and 5 GPs were the subjects. In the waiting room are two dedicated terminals. The first performs registration and includes fingerprint recognition. The second terminal allows patients to review their medical histories including prior consultation and referral letters. The control group was a similar practice where the subjects were 47 patients and 4 GPs. The results showed that despite the presence of the terminal most patients (38 out of 57) elected to do in person registration. There was no meaningful difference in registration time. There was an approximate 1 min shorter consultation time (10 min) among the 20% of patients who viewed their history prior to their provider encounter.

Commentary

The most interesting finding was the low utilization of computer based self registration. Additionally although registration times were similar, staff time savings for registration were offset by staff time additions to instruct patients how to do self registration. It appears that among the minority of patients who took advantage of reviewing their histories, less time was spent during their appointment as well as greater patient and provider satisfaction.

References

  1. Cauldwell, M., Beattie, C., Cox, B., Denby, W., Ede-Golightly, J., Linton, F. The impact of electronic patient records on workflow in general practice. Health Informatics J. 2007 Jun;13(2):155-60. http://www.ncbi.nlm.nih.gov/pubmed/17510226