The time needed for clinical documentation versus direct patient care - A work-sampling analysis of physicians' activities

Methods of Information in Medicine

Volumn 48, Issue 1, 2009, Pages 84-91

  Ammenwerth, Elske ^a   Spotl H P ^a  

^a UNIVERSITY FOR HEALTH SCIENCES   (Austria)

Author keywords

Documentation; Medical record systems; Physicians; Time and motion studies; Workload

Indexed keywords

DOCUMENTATION; EFFICIENCY, ORGANIZATIONAL; FORMS AND RECORDS CONTROL; HUMANS; MEDICAL INFORMATICS; MEDICAL RECORDS SYSTEMS, COMPUTERIZED; PATIENT CARE; PHYSICIAN'S PRACTICE PATTERNS; TIME FACTORS;

EID: 59349090596     PISSN: 00261270     EISSN: None     Source Type: Journal    
DOI: 10.3414/ME0569     Document Type: Article

References (34)

1. Haux R, Ammenwerth E, Herzog W, Knaup P. Health Care in the Information Society: A Prognosis for the Year 2013. Int J Med Inform 2002; 66 (1-3): 3-21.
2. BMGF. Krankenanstalten in Zahlen. 2006; Available from: http://www.kaz.bmgf.gv.at/. Last accessed: August 1, 2008.
3. Mechanic D. Physician discontent: challenges and opportunities. JAMA 2003; 290 (7): 941-946.
4. Probst JC, Greenhouse DL, Selassie AW. Patient and physician satisfaction with an outpatient care visit. J Fam Pract 1997; 45 (5): 418-425.
5. Brettenthaler R, Mayer H. Stopp der Zettelwirtschaft - Bürokratie macht krank [stop paper chaos - bureaucracy makes sick]. 2007. Available from: http://www.buerokratiestopp.at/statements.html. Last accessed: August 1, 2008.
6. Mayer H. Spitalsärztinnen in Österreich 2006. Ergebnis der Befragung für die Bundeskurie Angestellte Ärzte der österreichischen Ärztekammer. Österreichische Ärztekammer; 2006. http://www.ifes.at/upload/]156086926_folie.pdf. Last accessed: August 1, 2008.
7. Fontaine BR, Speedie S, Abelson D, Wold C. A work-sampling tool to measure the effect of electronic medical record implementation on health care workers. J Ambul Care Manage 2000; 23 (1): 71-85.
8. Gottschalk A, Flocke SA. Time spent in face-to-face patient care and work outside the examination room. Ann Fam Med 2005; 3 (6): 488-493.
9. Poissant L, Pereira J, Tamblyn R, Kawasumi Y. The impact of electronic health records on time efficiency of physicians and nurses: a systematic review. J Am Med Inform Assoc 2005; 12 (5): 505-516.
10. Ornstein C. California; Hospital Heeds Doctors, Suspends Use of Software: Cedars-Sinai physicians entered prescriptions and other orders in it, but called it unsafe. In: The Los Angeles Times, Jan 22; 2003.
11. Nickman NA, Guerrero RM, Bair JN. Self-reported work-sampling methods for evaluating pharmaceutical services. Am J Hosp Pharm 1990; 47 (7): 1611-1617.
12. Barnes R. Motion and Time Study Design and Measurement of Work. 6th ed. New York: John Wiley and Sons; 1968.
13. Tippett L. Statistical Methods in Textile Research. Uses of the Binomial and Poissant Distributions. J Textile Inst Trans 1935 (26): 51-55.
14. Pizziferri L, Kittler AF, Volk LA, Shulman LN, Kessler J, Carlson G, et al. Impact of an Electronic Health Record on oncologists' clinic time. AMIA Annu Symp Proc 2005. p 1083.
15. Overhage JM, Perkins S, Tierney WM, McDonald CJ. Controlled trial of direct physician order entry: effects on physicians' time utilization in ambulatory primary care internal medicine practices. J Am Med Inform Assoc 2001; 8 (4): 361-371.
16. Guarisco S, Oddone E, Simel D. Time analysis of a general medicine service: results from a random work sampling study. J Gen Intern Med 1994; 9(5): 272-277.
17. Wirth P, Kahn L, Perkoff GT. Comparability of two methods of time and motion study used in a clinical setting: work sampling and continuous observation. Med Care 1977; 15 (11): 953-960.
18. Finkler SA, Knickman JR, Hendrickson G, Lipkin M, Jr, Thompson WG. A comparison of work-sampling and time-and-motion techniques for studies in health services research. Health Serv Res 1993; 28 (5): 577-597.
19. Mamlin JJ, Baker DH. Combined time-motion and work sampling study in a general medicine clinic. Med Care 1973; 11 (5): 449-456.
20. Sittig DF. Work Sampling: A Statistical Approach to Evaluation of the Effect of Computers on Work Patterns in The Healthcare Industry. Methods Inf Med 1993; 32 (2): 167-174.
21. Lechleitner G, Pfeiffer K-P, Wilhelmy I, Ball M. Cerner Millenium: The Innsbruck Experience. Methods Inf Med 2003; 42 (1): 8-15.
22. Blum K, Müller U. Dokumentationsaufwand im Ärztlichen Dienst der Krankenhäuser - Bestandsaufnahme und Verbesserungsvorschläge - Untersuchung in Auftrag der Deutschen Krankenhausgesellschaft [Clinical documentation effort in hospitals]. Düsseldorf: Wissenschaft und Praxis der Krankenhausökonomie (Band 11). Deutsche Krankenhaus Verlagsgesellschaft. ISBN 3-935762.22-4; 2003. http://www.dkvg.de/index.php?cat=c23_Wissenschaft-und-Praxis-der- Krankenhausoekonomie.html. Last accessed: August 1, 2008.
23. Castelein J. Analyse des Dokumentationsaufwands in ärztlichen Bereich und seine Auswirkung auf die Arbeitszeitbelastung von Krankenhaus-Ärzten am Beispiel des Landeskrankenhauses Innsbruck (Universitätskliniken). PhD thesis, UMIT - University for Health Sciences, Medical Informatics and Technology, Hall in Tyrol, Austria. In preparation; 2008.
24. Oddone E, Guarisco S, Simel D. Comparison of housestaff's estimates of their workday activities with results of a random work-sampling study. Acad Med 1993; 68 (11): 859-861.
25. Hollingsworth JC, Chisholm CD, Giles BK, Cordell WH, Nelson DR. How do physicians and nurses spend their time in the emergency department? Ann Emerg Med 1998; 31 (1): 87-91.
26. Westbrook JI, Ampt A, Kearney L, Rob MI. All in a day's work: an observational study to quantify how and with whom doctors on hospital wards spend their time. Med J Aust 2008; 188 (9): 506-509.
27. Leiner F, Haux R. Systematic Planning of Clinical Documentation. Methods Inf Med 1996; 35 (1): 25-34.
28. Lu YC, Xiao Y, Sears A, Jacko JA. A review and a ftamework of handheld computer adoption in healthcare. Int J Med Inform 2005; 74 (5): 409-422.
29. Wu RC, Straus SE. Evidence for handheld electronic medical records in improving care: a systematic review. BMC Med Inform Decis Malt 2006; 6: 26.
30. Kaushal R, Shojania KG, Bates DW. Effects of computerized physician order entry and clinical decision support systems on medication safety: a systematic review. Arch Intern Med 2003; 163 (12): 1409-1416.
31. Rothschild J. Computerized physician order entry in the critical care and general inpatient setting: a narrative review. J Crit Care 2004; 19 (4): 271-278.
32. Wipf JE, Fihn SD, Callahan CM, Phillips CM. How residents spend their time in clinic and the effects of clerical support. J Gen Intern Med 1994; 9 (12): 694-696.
33. Bürkle T, Kuch R, Prokosch HU, Dudeck J. Stepwise Evaluation of Information Systems in an University Hospital. Methods Inf Med 1999; 38 (1): 9-15.
34. Westbrook JI, Ampt A, Williamson M, Nguyen K, Kearney L. Methods for measuring the impact of health information technologies on clinicans' patterns of works and communication. In: Kuhn K, Warren J, Leong T-Y, editors. Medinfo 2007 - Proceedings of the 12th World Congress on Health (Medical) Informatics, Brisbane, August 20-24, 2007. Amsterdam: IOS Press; 2007. pp 1083-1087.