Replacing the Scalpel with a Computer Mouse: An Evaluation of Time Spent on EMR for Plastic Surgery Residents and Its Impact on Resident Training
Madison A. Oxford1, Caroline McLaughlin2, Christopher McLaughlin3, T. Shane Johnson2, and John Roberts2
1Penn State College of Medicine, USA; 2Dept of Surgery, Division of Plastic Surgery, Penn State Health Milton S. Hershey, USA; 3Dept of Surgery, Penn State Health Milton S. Hershey, USA
Background: Following the integration of the electronic medical record (EMR) into the healthcare system, concern has grown regarding EMR use on physician well-being. For surgical residents, time spent on the EMR increases the burden of a demanding, hourly-restricted schedule and detracts from time spent honing surgical skills. To characterize these burdens, we sought to describe EMR utilization patterns for plastic surgery residents.
Methods: Integrated plastic surgery resident EMR utilization from March 2019 to March 2020 was extracted via Cerner Analytics at a tertiary academic medical center. Time spent in the EMR on-duty (0600-1759) and off-duty (1800-0559), including chart review, orders, documentation, and patient discovery, was analyzed. Statistical analysis was performed through independent T-tests and ANOVA.
Results: Twelve plastic surgery residents spent an average of 94 ± 86 minutes/day on the EMR, one third of which was spent off-duty. Juniors (PGY 1-3) spent 123 ± 99 minutes/day versus seniors (PGY 4-6) who spent 61 ± 49 minutes/day (p-value < 0.01). (Figure 1) Seniors spent 23% of time on the EMR off-duty, compared with 40% for juniors (p-value < 0.01). Chart review comprised the majority (42%) of EMR usage, followed by patient discovery (22%), orders (14%), documentation (12%), other (6%), and messaging (1%). Seniors spent more time on patient discovery (25% versus 21%, p-value < 0.001), while juniors spent more time performing chart review (48% versus 36%, p-value = 0.19). (Figure 2)
Conclusion: Integrated plastic surgery residents average 1.5 hours on the EMR daily. Junior residents spend one hour more per day on the EMR, including more time off-duty and more time performing chart review.
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