Time-motion examination of electronic health record utilization and clinician workflows indicate frequent task switching and documentation burden

Abstract

Clinical documentation burden has been broadly acknowledged, yet few interprofessional measures of burden exist. Using interprofessional time-motion study (TMS) data, we evaluated clinical workflows with a focus on electronic health record (EHR) utilization and fragmentation among 47 clinicians: 34 advanced practice providers (APPs) and 13 registered nurses (RNs) from: an acute care unit (n=15 observations [obs]), intensive care unit (n_obs=14), ambulatory clinic (n_obs=3), and emergency department (n_obs=15). We examined workflow fragmentation, task-switch type, and task involvement. In our study, clinicians on average exhibited 1.4±0.6 switches per minute in their workflow. Eighty-four (19.6%) of the 429 task-switch types presented in the data accounted for 80.1% of all switches. Among those, data viewing- and data entry-related tasks were involved in 48.2% of all switches, indicating documentation burden may play a critical role in workflow disruptions. Therefore, interruption rate evaluated through task switches may serve as a proxy for measuring burden.