Impact of EHR Implementation on Surgical Times

A new study has assessed the impact of implementing a new electronic health records (EHR) system on operative times for ophthalmic procedures in outpatient departments and ambulatory surgical centers (ASC).

The study found that while implementing a new EHR system may lengthen operating room (OR) times, the increase is small and limited to surgeries that occurred within the first 100 days of implementation.

Investigators sought to evaluate the association of surgical setting and implementation of a new EHR with operative times through examining ophthalmic surgeries from July 2015 to Nov. 2016. Data included in the series came from 2 ASCs and 1 hospital outpatient department (HOPD) within The Johns Hopkins Wilmer Eye Institute.

Investigators extracted data from surgeries performed by ophthalmologists from 2 EHR systems. The institute had used Operating Room Management Information System as their EHR and made a hospital wide switch on July 1, 2016 to EpicCare from Epic Systems.

Data extracted included anesthesia (local or general), procedure, surgeon identity, and location (HOPD versus ASC). They also extracted several time stamps related to time in the operating room (OR) scheduled start time, scheduled stop time, room start, room stop, procedure start, procedure stop,

A total of 17,397 cases were identified within the 2 EHR systems and, after satisfying inclusion criteria, 11,064 cases were included in the study. Investigators assessed all 11,064 cases to determine how total OR times changed after implementation of the new EHR system. The data was categorized into 4 specific periods including pre-transition (365 days before the go-live date), 1 to 50 days after the go-live date (immediate post-transition), 51 to 100 days after the go-live data (intermediate post-transition), and 101 to 150 days after the go-live date (late post-transition).

Compared to the pre-transition period, the mean total OR time was 2.9 minutes longer in the immediate post-transition period and 1.2 minutes longer in the intermediate post-transition period after controlling for covariates. Investigators noted that mean total OR time was not significantly different when comparing the late post-transition period to the pre-transition period.

Investigators also analyzed 4034 cataract cases involving 8 attending surgeons. The total number of cataract cases identified was 7487, but the 4034 included in the sub analysis met additional inclusion criteria for surgeons who operated without trainee responsibilities and at each location type.

Compared to ASC, mean room duration in HOPD was 11.9 (95% CI, 11.1-12.6) minutes longer, mean procedure duration was 10.6 (95% CI, 9.8-11.4) minutes longer, mean turnaround time was 5.1 (95% CI, 4.3-6.0) minutes longer, and mean total OR time was 15.9 (95% CI, 14.7-17.0) minutes longer, after adjustment for covariates.

Authors noted multiple limitations within their study. They reviewed a full year of data prior to new EHR implementation and just 150 days in the post-transition period, which means results could have been impacted if operative times varied by time of year. The analysis may be impacted by case selection at HOPD versus ASC, as more complex cataracts and multiple patient comorbidity may have been preferentially at the HOPD.

In an invited commentary, Michael Chiang, MD, of the Casey Eye Institute at Oregon Health and Science University, wrote that the study results provide guidance for clinicians who may be considering a transition to a new EHR system.

“Overall, this study provides guidance for clinicians who are considering a transition between EHR systems, particularly in the operating room setting. I hope that follow-up work will examine more detailed analysis of the time and personnel requirements of EHR use, the quality and outcomes associated with clinical documentation, and the overall cost of care,” wrote Chiang.

This study, titled “Association of Surgical Setting and Deployment of a New Electronic Health Record With Ophthalmic Operative Times,” is published in JAMA Ophthalmology.