What’s New in the Patient Safety World

May 2019

Too Much Time on the EMR



Our April 2017 What's New in the Patient Safety World column “How Much Time Do We Actually Spend on the EMR?” discussed numerous studies documenting how much time various healthcare professionals are spending on electronic medical records, often at the expense of time directly interacting with patients.


Now a recent observational study of interns (Chaiyachati 2019) found that they spent a mean of 15.9 hours of a 24-hour period (66%) in indirect patient care, mostly interactions with the patient’s medical record or documentation. A mean of only 3.0 hours was spent in direct patient care (13%) and 1.8 hours in education (7%). This pattern was consistent across the 4 periods of the day. Direct patient care and education frequently occurred when interns were performing indirect patient care. Multitasking with 2 or more indirect patient care activities occurred frequently. The study confirms that interns spend more time participating in indirect patient care than interacting with patients or in dedicated educational activities. It serves as a wakeup call that we need to investigate ways to better balance our time between direct and indirect patient care.


Our April 2017 What's New in the Patient Safety World column “How Much Time Do We Actually Spend on the EMR?” noted some studies showing how use of scribes or other forms of dictation support may lead to freeing up more time for direct patient care. But is also again raised a concern that we may neglect import elements of the EMR. In our March 22, 2011 Patient Safety Tip of the Week “An EMR Feature Detrimental to Teamwork and Patient Safety” we noted a study that had very bothersome results. Hripcsak and colleagues (Hripcsak 2011) analyzed time spent authoring notes and time spent reading notes in the EMR. They found most users spent 90 minutes a day authoring notes, 30 minutes a day reading notes. But the bothersome feature was a striking disparity in the rates of notes read that were authored by various healthcare workers. They found 97% of attending notes were read by someone and 99% of resident notes were read by someone. But fewer than 20% of nurses’ notes were read by attendings or residents! And only 38% of nurse’s notes were read by other nurses. 16% of all notes were never read by anyone!


Electronic medical records bring great opportunities to improve patient care but, in their current state of the art, have a tendency to intrude on workflows and detract from face-to-face interaction with our patients.



See some of our other Patient Safety Tip of the Week columns dealing with unintended consequences of technology and other healthcare IT issues:

·        December 11, 2018 “Another NMBA Accident”

·        January 1, 2019 “More on Automated Dispensing Cabinet (ADC) Safety”

·        February 5, 2019 “Flaws in Our Medication Safety Technologies”






Chaiyachati KH, Shea JA, Asch DA, et al. Assessment of Inpatient Time Allocation Among First-Year Internal Medicine Residents Using Time-Motion Observations. JAMA Intern Med 2019; Published online April 15, 2019







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