PubMed · 10457629
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F S Downs. 1999. How much is enough?. https://doi.org/10.1016/s0897-1897(99)80100-1
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A systematic review of the literature was performed to examine the impact of electronic health records (EHRs) on documentation time of physicians and nurses and to identify factors that may explain efficiency differences across studies. In total, 23 papers met our inclusion criteria; five were randomized controlled trials, six were posttest control studies, and 12 were one-group pretest-posttest designs. Most studies (58%) collected data using a time and motion methodology in comparison to work sampling (33%) and self-report/survey methods (8%). A weighted average approach was used to combine results from the studies. The use of bedside terminals and central station desktops saved nurses, respectively, 24.5% and 23.5% of their overall time spent documenting during a shift. Using bedside or point-of-care systems increased documentation time of physicians by 17.5%. In comparison, the use of central station desktops for computerized provider order entry (CPOE) was found to be inefficient, increasing the work time from 98.1% to 328.6% of physician's time per working shift (weighted average of CPOE-oriented studies, 238.4%). Studies that conducted their evaluation process relatively soon after implementation of the EHR tended to demonstrate a reduction in documentation time in comparison to the increases observed with those that had a longer time period between implementation and the evaluation process. This review highlighted that a goal of decreased documentation time in an EHR project is not likely to be realized. It also identified how the selection of bedside or central station desktop EHRs may influence documentation time for the two main user groups, physicians and nurses.
In medical records review studies, information on the interrater reliability (IRR) of the data is seldom reported. This study assesses the IRR of data collected for a complex medical records review study. Elements selected for determining IRR included "demographic" data that require copying explicit information (e.g., gender, birth date), "free-text" data that require identifying and copying (e.g., chief complaints and diagnoses), and data that require abstractor judgment in determining what to record (e.g., whether heart disease was considered). Rates of agreement were assessed by the greatest number of answers (one to all n) that were the same. The IRR scores improved over time. At 1 month, the reliability for demographic data elements was very good, for free-text data elements was good, but for data elements requiring abstractor judgment was unacceptable (only 3.4 of six answers agreed, on average). All assessments after 6 months showed very good to excellent IRR. This study demonstrates that IRR can be evaluated and summarized, providing important information to the study investigators and to the consumer for assessing the reliability of the data and therefore the validity of the study results and conclusions. IRR information should be required for all large medical records studies.
AIM: To determine the rate of family violence documented during general practice consultations and describe clinical presentations. METHOD: A dataset of 447,809 computerised consultations involving 143,634 patients from 41 general practices throughout New Zealand was examined to identify consultations recording family violence issues. The documentation rate was determined and the subset analysed. RESULTS: A subset of 337 consultations from the 447,809 examined (0.075%) involved a family violence issue. This subset included 311 patients, 0.2% of the 143,634 patients in the original 6-month dataset. 225 (81%) of the patients in the subset were female. Family violence was the main reason for presentation in 137 (40%) consultations. The perpetrator was identified as the partner in 134 (40%) consultations, as the parent in 54 (16%) consultations and the patient identified themselves as the possible abuser in 17 (5%) consultations. Physical abuse (42%) and sexual abuse (26%) was most commonly mentioned. Past abuse (42%) was discussed as often as current abuse (41%). Depression and anxiety disorders were documented in 59 (18%) of these consultations. CONCLUSIONS: The number of consultations documenting family violence is low in this dataset. Such information is not always recorded, however GPs can also be reluctant to ask about, and patients can be hesitant to disclose family violence issues. The number of consultations involving the perpetrator was higher than expected. GPs require training to deal with both the victim and the perpetrator of family violence.