EMR efficiencies and optimizations: differences between residents and non-resident physicians

Purpose Following a decade of rapid installation of electronic medical records (EMR), many clinicians are now focused on improving and updating those systems. Using the informatics optimization program dedicated to continuous improvement of the EMR at our institution (Uplift), physicians have been able to decrease the time spent in the EMR and realize efficiencies. Given their integral role in clinical care at teaching institutions, resident physician efficiencies are important and unique from non-residents. The primary objective was to provide EMR optimizations and measure their impact on resident physician efficiencies. The secondary objective was to identify unique trends to the resident physician need for efficiency and support. Methods The health system shares a common EHR instance across the 19 hospitals and several hundred ambulatory clinical locations. EHR vendor administers a database of use analytics for evaluation of adoption and other metrics. Active time and activities in the chart are algorithmically determined based on a proprietary combination of mouse and keyboard input. The data can be filtered by provider position and other elements. Using this tool, approximately 3728 residents and 2548 "non-resident" physicians EMR activities between March 2017 to February 2018 were reviewed, focusing on the ambulatory setting and two metrics (total time in EMR per patient and after hours charting). During the study period, there were resident specific improvements, improvements targeting non-residents and specific specialties, and general performance improvements that benefited all positions. Non-residents included supervising attending faculty and attending physicians who work without resident physicians. Results Resident physicians showed an upward trend each month in the time in the EMR per patient, and averaged 25 minutes, 6 seconds over the 23 month study period. Standard non-resident physician averaged 12 minutes, 54 seconds and showed a downward trend. Specialty groups who underwent improvements averaged 14 minutes, 53 seconds and showed a slight upward trend. All three groups reflected downward trend in the amount of time spent charting after hours, the specialty group had the highest proportion of time (15.77%). Conclusion Optimizations and improvements can have global benefit, but sustained improvements require more targeted design. Resident physicians have not experienced the same time savings that non-resident physicians during our optimiz