Abstract
Purpose: To compare accuracy and speed of keyboard and mouse electronic health record (EHR) documentation strategies with those of a paper documentation strategy. Design: Prospective cohort study. Methods: Three documentation strategies were developed: (1) keyboard EHR, (2) mouse EHR, and (3) paper. Ophthalmology trainees recruited for the study were presented with 5 clinical cases and documented findings using each strategy. For each case-strategy pair, findings and documentation time were recorded. Accuracy of each strategy was calculated based on sensitivity (fraction of findings in actual case that were documented by subject) and positive ratio (fraction of findings identified by subject that were present in the actual case). Results: Twenty subjects were enrolled. A total of 258 findings were identified in the 5 cases, resulting in 300 case-strategy pairs and 77 400 possible total findings documented. Sensitivity was 89.1% for the keyboard EHR, 87.2% for mouse EHR, and 88.6% for the paper strategy (no statistically significant differences). The positive ratio was 99.4% for the keyboard EHR, 98.9% for mouse EHR, and 99.9% for the paper strategy (P <.001 for mouse EHR vs paper; no significant differences between other pairs). Mean ± standard deviation documentation speed was significantly slower for the keyboard (2.4 ± 1.1 seconds/finding) and mouse (2.2 ± 0.7 seconds/finding) EHR compared with the paper strategy (2.0 ± 0.8 seconds/finding). Documentation speed of the mouse EHR strategy worsened with repetition. Conclusions: No documentation strategy was perfectly accurate in this study. Documentation speed for both EHR strategies was slower than with paper. Further studies involving total physician time requirements for ophthalmic EHRs are required.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 165-172.e2 |
| Journal | American journal of ophthalmology |
| Volume | 156 |
| Issue number | 1 |
| DOIs | |
| State | Published - Jul 2013 |
Funding
Dr Michael F. Chiang is Knowles Professor of Ophthalmology & Medical Informatics and Clinical Epidemiology at Oregon Health & Science University (OHSU), and is a Vice-Chair for Research in the Department of Ophthalmology at OHSU. His clinical practice focuses on pediatric ophthalmology. His research involves telemedicine, clinical information systems, and image analysis. His lab has been funded by the National Institutes of Health (NIH), and by several charitable foundations, since 2003. He received a BS in Electrical Engineering & Biology from Stanford, and an MD from Harvard Medical School and the Harvard-Massachusetts Institute of Technology Division of Health Sciences & Technology, and an MA in Biomedical Informatics from Columbia University where he was an NIH/NLM (National Library of Medicine) Fellow. He completed residency and pediatric ophthalmology fellowship training at the Johns Hopkins Wilmer Eye Institute. He is chair of the American Academy of Ophthalmology Medical Information Technology Committee, and serves on numerous other national committees. He is on the editorial boards for the Journal of the American Association for Pediatric Ophthalmology & Strabismus and the Journal of the American Medical Informatics Association ( JAMIA ), and is an Assistant Editor for JAMIA . All authors have completed and submitted the ICMJE form for disclosure of potential conflicts of interest and none were reported. Supported by unrestricted departmental funding from Research to Prevent Blindness, Inc , New York, New York, to Drs Chan, Thyparampil, and Chiang. Involved in Design of study (P.C., P.J.T., M.F.C.); Conduct of study (P.C., P.J.T., M.F.C.); Collection and management of data (P.C., P.J.T., M.F.C.); Analysis and interpretation of data (P.C., P.J.T., M.F.C.); Preparation of manuscript (P.C., P.J.T., M.F.C.); and Review and approval of manuscript (P.C., P.J.T., M.F.C.).
ASJC Scopus subject areas
- Ophthalmology