Abstract: The electronic medical record is often considered a cause of physician dissatisfaction and burnout. Recently at least one major EMR vendor (Epic) has started providing its organizations with user activity logs. Epic’s “Signal” profile contains information on hundreds of activities providers perform while using the ambulatory component of the EMR. Time measurement begins at login and pauses when there has been no system activity for five seconds.

MultiCare Health Systems is an 8-hospital healthcare organization in Washington state. Using Signal data for all of our ambulatory providers, we developed an efficiency metric: minutes spent in the ambulatory component of Epic per ambulatory appointment. We compared how individual providers and members of different specialties performed. To determine those factors associated with efficient use of the EMR, we created two multivariate models that predicted minutes in the EMR per appointment. The first model, "Who You Are", considers variables associated with the characteristics of providers, including time with the organization, gender and specialty. The second model, "What You Do", looks how different actions providers perform predict time in the EMR. We found that the number of messages a provider receives, the average number of items on patients’ problem lists, the length of progress notes, the amount of the note entered using manual typing, and the number visits coded at level 5 were associated with increased time per appointment. Those variables associated with less EMR time per appointment include the percentage of visits closed the same day, the number of preconfigured documentation elements created, the percentage of orders placed from preconfigured templates, and the amount of the note entered using documentation tools. This information is actionable since many of these variables can be modified with relatively little additional EMR training of either the provider or support staff.

An Ignite-style Talk would be an ideal format for rapid presentation of the statistical analysis.

Describe the new knowledge and additional skills the participant will gain after attending your presentation.: Participants will be aware that electronic medical record providers track user activity in their system, and at least one, Epic, shares this with organizations. This information can be used to help identify struggling providers.

The presentation will focus on those factors positively and negatively associated with efficient use of the ambulatory EMR for a medium-sized healthcare system in Washington state.

Some factors associated with inefficient EMR usage can be improved by additional EMR training of providers or modifying workflows for support staff. This may serve to improve EMR satisfaction and decrease provider burnout.

Authors:

Christopher Kelly (Presenter)
MultiCare Health Systems

Becket Mahnke, MultiCare Health Systems
Brett Walker, MultiCare Health Systems
Charles Laudenbach, MultiCare Health Systems