Evaluating and Improving an Outpatient Clinic Scheduling Template Using Secondary Electronic Health Record Data.

Improving the efficiency of outpatient clinics is challenging in the face of increased patient loads, decreased reimbursements and potential negative productivity impacts of using electronic health records (EHR). We modeled outpatient ophthalmology clinic workflow using discrete event simulation for testing new scheduling templates that decrease patient wait time and improve clinic efficiency. Despite challenges in implementing the new scheduling templates in one outpatient clinic, the new templates improved patient wait time and clinic session length when they were followed.

Quantifying the Impact of Trainee Providers on Outpatient Clinic Workflow using Secondary EHR Data.

Providers today face productivity challenges including increased patient loads, increased clerical burdens from new government regulations and workflow impacts of electronic health records (EHR). Given these factors, methods to study and improve clinical workflow continue to grow in importance. Despite the ubiquitous presence of trainees in academic outpatient clinics, little is known about the impact of trainees on academic workflow.

Association of the Presence of Trainees With Outpatient Appointment Times in an Ophthalmology Clinic.

Importance: Physicians face pressure to improve clinical efficiency, particularly with electronic health record (EHR) adoption and gradual shifts toward value-based reimbursement models. These pressures are especially pronounced in academic medical centers, where delivery of care must be balanced with medical education. However, the association of the presence of trainees with clinical efficiency in outpatient ophthalmology clinics is not known.

Time Requirements for Electronic Health Record Use in an Academic Ophthalmology Center.

Importance: Electronic health record (EHR) systems have transformed the practice of medicine. However, physicians have raised concerns that EHR time requirements have negatively affected their productivity. Meanwhile, evolving approaches toward physician reimbursement will require additional documentation to measure quality and cost of care.

Secondary use of electronic health record data for clinical workflow analysis.

Objective: Outpatient clinics lack guidance for tackling modern efficiency and productivity demands. Workflow studies require large amounts of timing data that are prohibitively expensive to collect through observation or tracking devices. Electronic health records (EHRs) contain a vast amount of timing data - timestamps collected during regular use - that can be mapped to workflow steps.

Clinic Workflow Simulations using Secondary EHR Data.

Clinicians today face increased patient loads, decreased reimbursements and potential negative productivity impacts of using electronic health records (EHR), but have little guidance on how to improve clinic efficiency. Discrete event simulation models are powerful tools for evaluating clinical workflow and improving efficiency, particularly when they are built from secondary EHR timing data. The purpose of this study is to demonstrate that these simulation models can be used for resource allocation decision making as well as for evaluating novel scheduling strategies in outpatient ophthalmology clinics.

Electronic health record impact on productivity and efficiency in an academic pediatric ophthalmology practice.

Purpose: To measure the effect of electronic health record (EHR) implementation on productivity and efficiency in the pediatric ophthalmology division at an academic medical center.

Methods: Four established providers were selected from the pediatric ophthalmology division at the Oregon Health & Science University Casey Eye Institute. Clinical volume was compared before and after EHR implementation for each provider.

Impact of an electronic health record operating room management system in ophthalmology on documentation time, surgical volume, and staffing.

Importance: Although electronic health record (EHR) systems have potential benefits, such as improved safety and quality of care, most ophthalmology practices in the United States have not adopted these systems. Concerns persist regarding potential negative impacts on clinical workflow. In particular, the impact of EHR operating room (OR) management systems on clinical efficiency in the ophthalmic surgery setting is unknown.

Time-motion analysis of clinical nursing documentation during implementation of an electronic operating room management system for ophthalmic surgery.

Efficiency and quality of documentation are critical in surgical settings because operating rooms are a major source of revenue, and because adverse events may have enormous consequences. Electronic health records (EHRs) have potential to impact surgical volume, quality, and documentation time. Ophthalmology is an ideal domain to examine these issues because procedures are high-throughput and demand efficient documentation.

Evaluation of electronic health record implementation in ophthalmology at an academic medical center (an American Ophthalmological Society thesis).

Purpose: To 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.

Methods: An academic ophthalmology department implemented an EHR in 2006.

Electronic health record systems in ophthalmology: impact on clinical documentation.

Objective: To evaluate quantitative and qualitative differences in documentation of the ophthalmic examination between paper and electronic health record (EHR) systems.

Design: Comparative case series.

Participants: One hundred fifty consecutive pairs of matched paper and EHR notes, documented by 3 attending ophthalmologist providers.