title: Emergency medicine resident physicians' perceptions of electronic documentation and workflow: a mixed methods study.
abstract: OBJECTIVE
  To understand emergency department (ED) physicians' use of electronic documentation in order to identify usability and workflow considerations for the design of future ED information system (EDIS) physician documentation modules.
  
  
  METHODS
  We invited emergency medicine resident physicians to participate in a mixed methods study using task analysis and qualitative interviews. Participants completed a simulated, standardized patient encounter in a medical simulation center while documenting in the test environment of a currently used EDIS. We recorded the time on task, type and sequence of tasks performed by the participants (including tasks performed in parallel). We then conducted semi-structured interviews with each participant. We analyzed these qualitative data using the constant comparative method to generate themes.
  
  
  RESULTS
  Eight resident physicians participated. The simulation session averaged 17 minutes and participants spent 11 minutes on average on tasks that included electronic documentation. Participants performed tasks in parallel, such as history taking and electronic documentation. Five of the 8 participants performed a similar workflow sequence during the first part of the session while the remaining three used different workflows. Three themes characterize electronic documentation: (1) physicians report that location and timing of documentation varies based on patient acuity and workload, (2) physicians report a need for features that support improved efficiency; and (3) physicians like viewing available patient data but struggle with integration of the EDIS with other information sources.
  
  
  CONCLUSIONS
  We confirmed that physicians spend much of their time on documentation (65%) during an ED patient visit. Further, we found that resident physicians did not all use the same workflow and approach even when presented with an identical standardized patient scenario. Future EHR design should consider these varied workflows while trying to optimize efficiency, such as improving integration of clinical data. These findings should be tested quantitatively in a larger, representative study.
authors.affiliation: Clinical & Quality Analysis , Partners HealthCare System, Wellesley, MA.
authors.forename: P M
authors.initials: PM
authors.lastname: Neri
authors.affiliation: Clinical & Quality Analysis , Partners HealthCare System, Wellesley, MA.
authors.forename: L
authors.initials: L
authors.lastname: Redden
authors.affiliation: Brigham and Women's Hospital , Boston, MA ; Neil and Elise Wallace STRATUS Center for Medical Simulation ; Simulation Consulting , Phoenix, Arizona, USA.
authors.forename: S
authors.initials: S
authors.lastname: Poole
authors.affiliation: Brigham and Women's Hospital , Boston, MA ; Neil and Elise Wallace STRATUS Center for Medical Simulation ; Harvard Medical School , Boston, MA.
authors.forename: C N
authors.initials: CN
authors.lastname: Pozner
authors.affiliation: Brigham and Women's Hospital , Boston, MA ; Harvard Medical School , Boston, MA.
authors.forename: J
authors.initials: J
authors.lastname: Horsky
authors.affiliation: Brigham and Women's Hospital , Boston, MA ; Harvard Medical School , Boston, MA.
authors.forename: A S
authors.initials: AS
authors.lastname: Raja
authors.affiliation: Boston Medical Center, Boston University School of Medicine , Boston, MA.
authors.forename: E
authors.initials: E
authors.lastname: Poon
authors.affiliation: Brigham and Women's Hospital , Boston, MA ; Harvard Medical School , Boston, MA.
authors.forename: G
authors.initials: G
authors.lastname: Schiff
authors.affiliation: Brigham and Women's Hospital , Boston, MA ; Harvard Medical School , Boston, MA.
authors.forename: A
authors.initials: A
authors.lastname: Landman
mesh_terms: D004282:Documentation / Q000379:methods*; D057286:Electronic Health Records; D004635:Emergency Medicine / Q000379:methods*; D004636:Emergency Service, Hospital; D006801:Humans; D007396:Internship and Residency; D008297:Male; D008875:Middle Aged; D010820:Physicians; D013997:Time Factors; D057188:Workflow
keywords: Workflow; electronic documentation; electronic health records; emergency department
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