title: Impact of an electronic health record operating room management system in ophthalmology on documentation time, surgical volume, and staffing.
abstract: OBJECTIVE
  Although electronic health record (EHR) systems have potential benefits, such as improved safety and quality of care, most ophthalmology practices in the United States have not adopted these systems. Concerns persist regarding potential negative impacts on clinical workflow. In particular, the impact of EHR operating room (OR) management systems on clinical efficiency in the ophthalmic surgery setting is unknown.
  
  
  OBJECTIVE
  To determine the impact of an EHR OR management system on intraoperative nursing documentation time, surgical volume, and staffing requirements.
  
  
  METHODS
  For documentation time and circulating nurses per procedure, a prospective cohort design was used between January 10, 2012, and January 10, 2013. For surgical volume and overall staffing requirements, a case series design was used between January 29, 2011, and January 28, 2013. This study involved ophthalmic OR nurses (n = 13) and surgeons (n = 25) at an academic medical center.
  
  
  METHODS
  Electronic health record OR management system implementation.
  
  
  METHODS
  (1) Documentation time (percentage of operating time documenting [POTD], absolute documentation time in minutes), (2) surgical volume (procedures/time), and (3) staffing requirements (full-time equivalents, circulating nurses/procedure). Outcomes were measured during a baseline period when paper documentation was used and during the early (first 3 months) and late (4-12 months) periods after EHR implementation.
  
  
  RESULTS
  There was a worsening in total POTD in the early EHR period (83%) vs paper baseline (41%) (P < .001). This improved to baseline levels by the late EHR period (46%, P = .28), although POTD in the cataract group remained worse than at baseline (64%, P < .001). There was a worsening in absolute mean documentation time in the early EHR period (16.7 minutes) vs paper baseline (7.5 minutes) (P < .001). This improved in the late EHR period (9.2 minutes) but remained worse than in the paper baseline (P < .001). While cataract procedures required more circulating nurses in the early EHR (mean, 1.9 nurses/procedure) and late EHR (mean, 1.5 nurses/procedure) periods than in the paper baseline (mean, 1.0 nurses/procedure) (P < .001), overall staffing requirements and surgical volume were not significantly different between the periods.
  
  
  CONCLUSIONS
  Electronic health record OR management system implementation was associated with worsening of intraoperative nursing documentation time especially in shorter procedures. However, it is possible to implement an EHR OR management system without serious negative impacts on surgical volume and staffing requirements.
authors.affiliation: Department of Ophthalmology, Casey Eye Institute, Oregon Health & Science University, Portland.
authors.forename: David S
authors.initials: DS
authors.lastname: Sanders
authors.affiliation: Department of Ophthalmology, Casey Eye Institute, Oregon Health & Science University, Portland.
authors.forename: Sarah
authors.initials: S
authors.lastname: Read-Brown
authors.affiliation: Department of Ophthalmology, Casey Eye Institute, Oregon Health & Science University, Portland2Operative Care Division, Ophthalmology, Portland VA Medical Center, Portland, Oregon.
authors.forename: Daniel C
authors.initials: DC
authors.lastname: Tu
authors.affiliation: Department of Public Health and Preventive Medicine, Oregon Health & Science University, Portland.
authors.forename: William E
authors.initials: WE
authors.lastname: Lambert
authors.affiliation: Department of Public Health and Preventive Medicine, Oregon Health & Science University, Portland.
authors.forename: Dongseok
authors.initials: D
authors.lastname: Choi
authors.affiliation: Department of Ophthalmology, Casey Eye Institute, Oregon Health & Science University, Portland.
authors.forename: Bella M
authors.initials: BM
authors.lastname: Almario
authors.affiliation: Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland.
authors.forename: Thomas R
authors.initials: TR
authors.lastname: Yackel
authors.affiliation: Department of Ophthalmology, Casey Eye Institute, Oregon Health & Science University, Portland.
authors.forename: Anna S
authors.initials: AS
authors.lastname: Brown
authors.affiliation: Department of Ophthalmology, Casey Eye Institute, Oregon Health & Science University, Portland4Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland.
authors.forename: Michael F
authors.initials: MF
authors.lastname: Chiang
mesh_terms: D000046:Academic Medical Centers; D000328:Adult; D000368:Aged; D004282:Documentation / Q000379:methods*; D057286:Electronic Health Records / Q000458:organization & administration*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009873:Operating Rooms / Q000458:organization & administration*; D009885:Ophthalmology / Q000458:organization & administration*; D009922:Oregon; D010561:Personnel Staffing and Scheduling / Q000458:organization & administration*; D011446:Prospective Studies; D058996:Quality Improvement; D013997:Time Factors