The impact of electronic patient records on workflow in general practice

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Article Review #2

Cauldwell, M., Beattie, C., Cox, B., Denby, W., Ede-Golightly, J., Linton, F. The impact of electronic patient records on workflow in general practice.

Introduction/Background:

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.

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.

Practitioners:

                                                          Wells Park:                    South Lewisham: 
                                                     Pre-PAERS   Post-PAERS        Without PAERS   If PAERS

Proportion of time spent explaining results/reports: 23.3% 19.3% 24.2% 36.3%(perceived)

Proportion of time spent correcting inaccuracies: 8.5% 6.5% 7.1% 14.2%(perceived)

Proportion of time spent explaining written notes: 16.1% 11.5% 7.1% 16.7%(perceived)


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.

Anuj K. Dalal, M.D.