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The Laryngoscope © 2020 American Laryngological, Rhinological and Otological Society Inc, "The Triological Society" and American Laryngological Association (ALA)

National Trends in Daily Ambulatory Electronic Health Record Use by Otolaryngologists

John Paul Giliberto, MD ; Gregory Ator, MD; Thomas L. Carroll, MD ; Teresa Chan, MD; Andrew Vahabzadeh-Hagh, MD

Objective: Since their development in the 1970s electronic health records (EHRs) are now nearly ubiquitous. This study aims to characterize the daily interactions of otolaryngology providers with EHRs. Methods: This study was a cross-sectional review of provider ef fi ciency pro fi le (PEP) data, as collected by a major EHR vendor. Participating institutions had 6 months of de-identi fi ed PEP data reviewed starting January 1, 2019. PEP data is gener ated for providers with scheduled patients, both attendings and advanced practice providers (APPs). Time metrics are recorded when a provider is interacting with the EHR including a 5-second time-out for inactivity. Results: Data on 269 otolaryngologists and 29 APPs from 10 institutions were evaluated. On scheduled ambulatory clinic days attendings spent 70 36 (mean standard deviation) min interacting in the EHR versus 108 46 min for APPs. Of the daily EHR time, mean time in notes, clinical review, in basket, orders, and schedule were 30.1 19.4, 9.6 6.1, 7.3 5.8, and 5.8 7.6 min, respectively. Per patient visit, median (interquartile range) time in notes, clinical review, and orders were 3.19 (2.2 – 4.9), 1.14 (0.63 – 1.8), and 0.70 (0.47 – 1.05) min, respectively. Mean progress note length was 4638 2143 characters. Conclusion: Otolaryngology providers spend a meaningful portion of their clinic day interacting with the EHR. PEP data may provide means to target interventions and a metric to measure the impact of those interventions on provider EHR ef fi ciency. KeyWords: Otolaryngology time in HER, electronic health record, provider ef fi ciency. Level of Evidence: 3 Laryngoscope , 131:975 – 981, 2021

INTRODUCTION There is has been an increasing recognition of the rise of physician burnout both in otolaryngology as a spe cialty and medicine as a whole. 1 – 3 As this discussion of physician burnout has matured over the past decade, the national conversation has turned from characterization of prevalence and risk factors of burnout to exploring inter ventions to support physician wellness. 4,5 The electronic health record (EHR) has been cited by both medical liter ature 6,7 and mainstream media, 8,9 as the source of this epidemic of physician burnout. Other authors would argue that the EHR has a nuanced role in physician burnout and the contributing factors to burnout are com plex. 10,11 While this debate is unlikely to be settled From the Department of Otolaryngology - Head and Neck Surgery ( J . P . G .), University of Washington Medical Center, Seattle, Washington, U.S.A.; Department of Otolaryngology Head and Neck Surgery ( G . A .), University of Kanas School of Medicine, Kansas City, Kansas, U.S.A.; Department of Otolaryngology-Head and Neck Surgery ( T . L . C .), Harvard Medical School, Boston, Massachusetts, U.S.A.; Department of Otolaryngology-Head and Neck Surgery ( T . C .), University of Texas Southwestern Medical Center, Dallas, Texas, U.S.A.; and the Department of Surgery - Otolaryngology/Head & Neck Surgery ( A . V .- H .), University of California, San Diego, San Diego, California, U.S.A. Editor ’ s Note: This Manuscript was accepted for publication on August 14, 2020. The authors have no funding, fi nancial relationships, or con fl icts of interest to disclose. Poster Presentation at the Triological Society Sectionals Meeting January 24, 2020, in San Diego, CA. Send correspondence to John Paul Giliberto, MD, 1959 NE Paci fi c St, Box 365515, Seattle, WA 98195. E-mail: jpgent@uw.edu

anytime soon, improved functionality of EHRs could be leveraged to support physician wellness, by better targeting wellness interventions and using provider ef fi ciency data to measure the impact of these initiatives. As part of their standard foundation software package, an international EHR vendor (Epic Systems Corporation) has each customer institution collect data on user interac tions with the EHR. This data is uploaded to the vendor on a monthly basis and then compiled and analyzed to create the provider ef fi ciency pro fi le (PEP). Through the vendor ’ s web-based Signal portal, each institution had access to their own data and a proprietary interface that allows users to compare their monthly PEP data to institutional, as well as EHR vendor-wide, aggregate data. By pooling national PEP data from many institutions, it is possible to estimate the time that otolaryngologists across the United States spend interacting with this speci fi c EHR. It is the aim of this study to characterize the daily and per appoint ment PEP trends for otolaryngologists through a multi institutional descriptive study, thus providing the ground work to leverage these measures for provider ef fi ciency initiatives in otolaryngology. METHODS An application for determination as not human research was submitted to the institutional review board at the institution of the primary author (J.P.G) and the study was determined to not be human research (STUDY00007825). Once agreement was obtained from each participating institution ’ s medical informat ics leadership (chief medical information of fi cer [CMIO],

DOI: 10.1002/lary.29073

Laryngoscope 131: May 2021

Giliberto et al.: National Time Spent in EHR 975