title: Impact of electronic health record technology on the work and workflow of physicians in the intensive care unit.
abstract: OBJECTIVE
  To assess the impact of EHR technology on the work and workflow of ICU physicians and compare time spent by ICU resident and attending physicians on various tasks before and after EHR implementation.
  
  
  METHODS
  EHR technology with electronic order management (CPOE, medication administration and pharmacy system) and physician documentation was implemented in October 2007.
  
  
  METHODS
  We collected a total of 289 h of observation pre- and post-EHR implementation. We directly observed the work of residents in three ICUs (adult medical/surgical ICU, pediatric ICU and neonatal ICU) and attending physicians in one ICU (adult medical/surgical ICU).
  
  
  RESULTS
  EHR implementation had an impact on the time distribution of tasks as well as the temporal patterns of tasks. After EHR implementation, both residents and attending physicians spent more of their time on clinical review and documentation (40% and 55% increases, respectively). EHR implementation also affected the frequency of switching between tasks, which increased for residents (from 117 to 154 tasks per hour) but decreased for attendings (from 138 to 106 tasks per hour), and the temporal flow of tasks, in particular around what tasks occurred before and after clinical review and documentation. No changes in the time spent in conversational tasks or the physical care of the patient were observed.
  
  
  CONCLUSIONS
  The use of EHR technology has a major impact on ICU physician work (e.g., increased time spent on clinical review and documentation) and workflow (e.g., clinical review and documentation becoming the focal point of many other tasks). Further studies should evaluate the impact of changes in physician work on the quality of care provided.
authors.affiliation: Center for Quality and Productivity Improvement, University of Wisconsin-Madison, 3130 Engineering Centers Building, 1550 Engineering Drive, Madison, WI 53706, United States; Department of Industrial and Systems Engineering, University of Wisconsin-Madison, 3270 Mechanical Engineering Building, 1513 University Avenue, Madison, WI 53706, United States. Electronic address: carayon@engr.wisc.edu.
authors.forename: Pascale
authors.initials: P
authors.lastname: Carayon
authors.affiliation: Center for Quality and Productivity Improvement, University of Wisconsin-Madison, 3130 Engineering Centers Building, 1550 Engineering Drive, Madison, WI 53706, United States; Department of Industrial and Systems Engineering, University of Wisconsin-Madison, 3270 Mechanical Engineering Building, 1513 University Avenue, Madison, WI 53706, United States; School of Medicine and Public Health, University of Wisconsin-Madison, 600 Highland Avenue, Madison, WI 53792, United States. Electronic address: tbw@medicine.wisc.edu.
authors.forename: Tosha B
authors.initials: TB
authors.lastname: Wetterneck
authors.affiliation: Center for Quality and Productivity Improvement, University of Wisconsin-Madison, 3130 Engineering Centers Building, 1550 Engineering Drive, Madison, WI 53706, United States. Electronic address: bashar.m.alyousef@gmail.com.
authors.forename: Bashar
authors.initials: B
authors.lastname: Alyousef
authors.affiliation: School of Nursing, University of Wisconsin-Madison, 600 Highland Avenue, Madison, WI 53792, United States; School of Medicine and Public Health, University of Wisconsin-Madison, 600 Highland Avenue, Madison, WI 53792, United States. Electronic address: rlbrown3@wisc.edu.
authors.forename: Roger L
authors.initials: RL
authors.lastname: Brown
authors.affiliation: Center for Quality and Productivity Improvement, University of Wisconsin-Madison, 3130 Engineering Centers Building, 1550 Engineering Drive, Madison, WI 53706, United States. Electronic address: rcartmill@cqpi.engr.wisc.edu.
authors.forename: Randi S
authors.initials: RS
authors.lastname: Cartmill
authors.affiliation: Center for Quality and Productivity Improvement, University of Wisconsin-Madison, 3130 Engineering Centers Building, 1550 Engineering Drive, Madison, WI 53706, United States. Electronic address: kerrymcguire@gmail.com.
authors.forename: Kerry
authors.initials: K
authors.lastname: McGuire
authors.affiliation: Center for Quality and Productivity Improvement, University of Wisconsin-Madison, 3130 Engineering Centers Building, 1550 Engineering Drive, Madison, WI 53706, United States. Electronic address: phoonakker@cqpi.engr.wisc.edu.
authors.forename: Peter L T
authors.initials: PL
authors.lastname: Hoonakker
authors.affiliation: Center for Research and Innovation in Systems Safety, Vanderbilt University School of Medicine, 1211 21st Avenue South, Medical Arts Building, Suite 732, Nashville, TN 37211, United States. Electronic address: Jason.slagle@vanderbilt.edu.
authors.forename: Jason
authors.initials: J
authors.lastname: Slagle
authors.affiliation: Center for Quality and Productivity Improvement, University of Wisconsin-Madison, 3130 Engineering Centers Building, 1550 Engineering Drive, Madison, WI 53706, United States. Electronic address: kkvanroy@gmail.com.
authors.forename: Kara S
authors.initials: KS
authors.lastname: Van Roy
authors.affiliation: Siemens Healthcare, 415 15th Street, New Cumberland, PA 17070, United States. Electronic address: James.M.Walker@siemens.com.
authors.forename: James M
authors.initials: JM
authors.lastname: Walker
authors.affiliation: Center for Research and Innovation in Systems Safety, Vanderbilt University School of Medicine, 1211 21st Avenue South, Medical Arts Building, Suite 732, Nashville, TN 37211, United States; Geriatric Research, Education and Clinical Center, VA Tennessee Valley Healthcare System, 1310 24th Avenue South, Nashville, TN 37212-2637, United States. Electronic address: Matt.weinger@vanderbilt.edu.
authors.forename: Matthew B
authors.initials: MB
authors.lastname: Weinger
authors.affiliation: Armstrong Institute for Patient Safety and Quality, Johns Hopkins University, 750 East Pratt Street, Baltimore, MD 21202, United States. Electronic address: axie1@jhmi.edu.
authors.forename: Anping
authors.initials: A
authors.lastname: Xie
authors.affiliation: Geisinger Health System, 100 North Academy Avenue, Danville, PA 17822, United States. Electronic address: kewood@geisinger.edu.
authors.forename: Kenneth E
authors.initials: KE
authors.lastname: Wood
mesh_terms: D000328:Adult; D002648:Child; D004282:Documentation / Q000379:methods*; D057286:Electronic Health Records / Q000706:statistics & numerical data*; D013502:General Surgery; D006801:Humans; D007362:Intensive Care Units; D010372:Pediatrics; D010820:Physicians; D011446:Prospective Studies; D013997:Time Factors; D057188:Workflow; D016526:Workload / Q000706:statistics & numerical data*
keywords: Critical care; Electronic health record; Human factors engineering; Physician work; Time study