• Michael F Chiang, Sarah Read-Brown, Daniel C Tu, Dongseok Choi, David S Sanders, Thomas S Hwang, Steven Bailey, Daniel J Karr, Elizabeth Cottle, John C Morrison, David J Wilson, and Thomas R Yackel.
• Department of Ophthalmology, Casey Eye Institute, Oregon Health & Science University, Portland (Dr Chiang, Ms Read-Brown, Dr Tu, Mr Sanders, Dr Choi, Dr Hwang, Dr Bailey, Dr Karr, Ms Cottle, Dr Morrison, Dr Wilson); Department of Medical Informatics & Clinical Epidemiology, Oregon Health & Science University, Portland (Dr Chiang, Dr Yackel); Operative Care Division, Portland VA Medical Center, Portland (Dr Tu); and Department of Public Health & Preventive Medicine, Oregon Health & Science University, Portland (Dr Choi).
• Trans Am Ophthalmol Soc. 2013 Sep 1;111:70-92.

PurposeTo evaluate three measures related to electronic health record (EHR) implementation: clinical volume, time requirements, and nature of clinical documentation. Comparison is made to baseline paper documentation.MethodsAn academic ophthalmology department implemented an EHR in 2006. A study population was defined of faculty providers who worked the 5 months before and after implementation. Clinical volumes, as well as time length for each patient encounter, were collected from the EHR reporting system. To directly compare time requirements, two faculty providers who utilized both paper and EHR systems completed time-motion logs to record the number of patients, clinic time, and nonclinic time to complete documentation. Faculty providers and databases were queried to identify patient records containing both paper and EHR notes, from which three cases were identified to illustrate representative documentation differences.ResultsTwenty-three faculty providers completed 120,490 clinical encounters during a 3-year study period. Compared to baseline clinical volume from 3 months pre-implementation, the post-implementation volume was 88% in quarter 1, 93% in year 1, 97% in year 2, and 97% in year 3. Among all encounters, 75% were completed within 1.7 days after beginning documentation. The mean total time per patient was 6.8 minutes longer with EHR than paper (P<.01). EHR documentation involved greater reliance on textual interpretation of clinical findings, whereas paper notes used more graphical representations, and EHR notes were longer and included automatically generated text.ConclusionThis EHR implementation was associated with increased documentation time, little or no increase in clinical volume, and changes in the nature of ophthalmic documentation.

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