title: Emergency Physician Task Switching Increases With the Introduction of a Commercial Electronic Health Record.
abstract: We evaluate how the transition from a homegrown electronic health record to a commercial one affects emergency physician work activities from initial introduction to long-term use.
  
  
  
  We completed a quasi-experimental study across 3 periods during the transition from a homegrown system to a commercially available electronic health record with computerized provider order entry. Observation periods consisted of pre-implementation, 1 month before the implementation of the commercial electronic health record; "go-live" 1 week after implementation; and post-implementation, 3 to 4 months after use began. Fourteen physicians were observed in each period (N=42) with a minute-by-minute observation template to record emergency physician time allocation across 5 task-based categories (computer, verbal communication, patient room, paper [chart/laboratory results], and other). The average number of tasks physicians engaged in per minute was also analyzed as an indicator of task switching.
  
  
  
  From pre- to post-implementation, there were no significant differences in the amount of time spent on the various task categories. There were changes in time allocation from pre-implementation to go-live and go-live to pre-implementation, characterized by a significant increase in time spent on computer tasks during go-live relative to the other periods. Critically, the number of tasks physicians engaged in per minute increased from 1.7 during pre-implementation to 1.9 during post-implementation (difference 0.19 tasks per minute; 95% confidence interval 0.039 to 0.35).
  
  
  
  The increase in the number of tasks physicians engaged in per minute post-implementation indicates that physicians switched tasks more frequently. Frequent task switching behavior raises patient safety concerns.
authors.affiliation: National Center for Human Factors in Healthcare, MedStar Health, Washington, DC; Department of Industrial and Systems Engineering, University at Buffalo, SUNY, Buffalo, NY.
authors.forename: Natalie C
authors.initials: NC
authors.lastname: Benda
authors.affiliation: National Center for Human Factors in Healthcare, MedStar Health, Washington, DC; Department of Applied-Experimental Psychology, Catholic University of America, Washington, DC.
authors.forename: Margaret L
authors.initials: ML
authors.lastname: Meadors
authors.affiliation: National Center for Human Factors in Healthcare, MedStar Health, Washington, DC; Department of Emergency Medicine, Georgetown University Medical Center, Washington, DC.
authors.forename: A Zachary
authors.initials: AZ
authors.lastname: Hettinger
authors.affiliation: National Center for Human Factors in Healthcare, MedStar Health, Washington, DC; Department of Emergency Medicine, Georgetown University Medical Center, Washington, DC. Electronic address: Raj.Ratwani@MedicalHFE.org.
authors.forename: Raj M
authors.initials: RM
authors.lastname: Ratwani
mesh_terms: D004282:Documentation / Q000379:methods; D057286:Electronic Health Records / Q000706:statistics & numerical data*; D004636:Emergency Service, Hospital / Q000458:organization & administration*; D006801:Humans; D010043:Outcome and Process Assessment, Health Care; D010818:Practice Patterns, Physicians'; D014481:United States; D016526:Workload / Q000706:statistics & numerical data*