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Restricted EHR Configuration Does Not Improve Clinician Efficiency, Study Finds

Restricting providers to opening one EHR record at a time did not reduce wrong-patient orders or clinician efficiency.

A restricted EHR configuration limited to one patient record open at a time did not impact clinician efficiency, despite perceptions that an unrestricted EHR was more efficient, according to a study published in JAMIA.

A prior randomized controlled trial showed no significant difference in wrong-patient errors between clinicians assigned to a restricted EHR configuration versus an unrestricted EHR configuration (allowing up to 4 records open concurrently). This substudy of the trial compared clinician efficiency between EHR configurations.

Among 2,556 clinicians, there was no significant difference between unrestricted and restricted groups in total active minutes per day overall or by clinician type and practice area.

Despite no difference in efficiency measures, the study participants reported greater efficiency in the unrestricted configuration. Clinicians in the restricted format reported frustrations at their inability to multitask, which prompted some to use potentially hazardous EHR workarounds.

“Therefore, although the unrestricted configuration was perceived as more efficient by clinicians, perhaps owing to the ability to open multiple records as needed, these results suggest no savings in time or effort on average based on EHR audit log metrics,” the study authors wrote.

The study’s findings support an unrestricted EHR configuration being as safe as a restricted configuration while being more clinician-centered.

The authors noted that the study has several strengths.

“First, clinicians were randomized to the different EHR configurations,” they wrote. “Second, a large number of clinicians in different roles and settings were included and analyzed in this study.”

However, the study also has multiple limitations.

First, it was a substudy of a larger RCT and not the primary outcome of the parent study.

Second, the researchers conducted the study in a single-center setting, potentially limiting generalizability.

Lastly, using total active minutes as a measure of efficiency captures just one dimension of a complex construct, the researchers pointed out.

“Measuring clinician efficiency involves many factors, including quantifying specific tasks in patient care and tasks completed per unit of time,” they wrote. “There may be unmeasured factors that explain clinicians’ perception of greater efficiency in the unrestricted arm in the parent RCT. However, total active minutes have been proposed as key metric to measure clinician efficiency.”

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