Asunto(s)
Registros Electrónicos de Salud , Médicos , Humanos , Pacientes Ambulatorios , Relaciones Médico-Paciente , TiempoRESUMEN
Background: The amount of time that providers spend using electronic health records (EHRs) to support the care delivery process is a concern for the U.S. health care system. Given the potential effect on patient care and the high costs related to this time, particularly for medical specialists whose work is largely cognitive, these findings warrant more precise documentation of the time physicians invest in these clinically focused EHR functions. Objective: To describe how much time ambulatory medical subspecialists and primary care physicians across several U.S. care delivery systems spend on various EHR functions. Design: Descriptive study. Setting: U.S.-based, adult, nonsurgical, ambulatory practices using the Cerner Millennium EHR. Participants: 155 000 U.S. physicians. Measurements: Data were extracted from software log files in the Lights On Network (Cerner) during 2018 that totaled the time spent on each of the 13 clinically focused EHR functions. Averages per encounter by specialty were computed. Results: This study included data from approximately 100 million patient encounters with about 155 000 physicians from 417 health systems. Physicians spent an average of 16 minutes and 14 seconds per encounter using EHRs, with chart review (33%), documentation (24%), and ordering (17%) functions accounting for most of the time. The distribution of time spent by providers using EHRs varies greatly within specialty. The proportion of time spent on various clinically focused functions was similar across specialties. Limitation: Variation by health system could not be examined, and all providers used the same software. Conclusion: The time spent using EHRs to support care delivery constitutes a large portion of the physicians' day, and wide variation suggests opportunities to optimize systems and processes. Primary Funding Source: None.
Asunto(s)
Instituciones de Atención Ambulatoria , Registros Electrónicos de Salud/estadística & datos numéricos , Visita a Consultorio Médico , Médicos , Pautas de la Práctica en Medicina , Estudios Transversales , Documentación/estadística & datos numéricos , Humanos , Sistemas de Entrada de Órdenes Médicas , Relaciones Médico-Paciente , Estudios de Tiempo y Movimiento , Estados UnidosAsunto(s)
Sistemas de Apoyo a Decisiones Clínicas , Difusión de Innovaciones , Registros Electrónicos de Salud/tendencias , Personal de Salud/organización & administración , Informática Médica/métodos , Farmacogenética , Sistemas de Apoyo a Decisiones Clínicas/organización & administración , Sistemas de Apoyo a Decisiones Clínicas/normas , Humanos , Difusión de la Información , Colaboración Intersectorial , Farmacogenética/métodos , Farmacogenética/tendencias , Medicina de Precisión/métodos , Medicina de Precisión/normas , Mejoramiento de la CalidadRESUMEN
BACKGROUND: There is tremendous potential for genome sequencing to improve clinical diagnosis and care once it becomes routinely accessible, but this will require formalizing research methods into clinical best practices in the areas of sequence data generation, analysis, interpretation and reporting. The CLARITY Challenge was designed to spur convergence in methods for diagnosing genetic disease starting from clinical case history and genome sequencing data. DNA samples were obtained from three families with heritable genetic disorders and genomic sequence data were donated by sequencing platform vendors. The challenge was to analyze and interpret these data with the goals of identifying disease-causing variants and reporting the findings in a clinically useful format. Participating contestant groups were solicited broadly, and an independent panel of judges evaluated their performance. RESULTS: A total of 30 international groups were engaged. The entries reveal a general convergence of practices on most elements of the analysis and interpretation process. However, even given this commonality of approach, only two groups identified the consensus candidate variants in all disease cases, demonstrating a need for consistent fine-tuning of the generally accepted methods. There was greater diversity of the final clinical report content and in the patient consenting process, demonstrating that these areas require additional exploration and standardization. CONCLUSIONS: The CLARITY Challenge provides a comprehensive assessment of current practices for using genome sequencing to diagnose and report genetic diseases. There is remarkable convergence in bioinformatic techniques, but medical interpretation and reporting are areas that require further development by many groups.