Gregory Schmidt, MD has a really fascinating post on his site that looks at how much time and money is lost with doctors waiting to login to their EHR. Here’s his high level findings:
a. It costs about $15 each time an ER physician logs into a computer
b. During an eight hour shift, an ER physician may spend up to an hour waiting on computers
c. A single ER may lose a million dollars of productivity annually from slow computers.
You can read the full post to see his methodology and the assumptions he made. Most of it looks pretty reasonable to me except for how long it takes for doctors to login to their EHR.
Based on my experience, the 2-5 minute estimate per login is high for most organizations. Yes, if you are running an environment where you have to login to the full O/S and then to the EHR, these estimates could be pretty good. However, those estimates seem very high for doctors that just need to login to their EHR. If it takes you 2-5 minutes to login to your EHR, then that’s a really poorly designed system.
Of course, the other solution that I see a lot of doctors use is some sort of portable laptop or tablet. This means that their login time is very little other than when they first start their day. The cons are that you have to lug a laptop around and in the hospital environment, they often don’t give everyone a laptop. You’d think they could all just carry tablets, but so far the EHR data entry on tablets has rarely been good.
This point aside, even if it takes 1-2 minutes to login to your EHR, that still is a ton of time wasted just logging into your EHR. This is particularly expensive in an environment where you have shared computers and so you have to often log people off and log yourself back in and the EHR systems largely don’t remember where you were previously.
Unfortunately I don’t see us doing much about this. I’ve seen some biometric solutions that make this a little bit better. So, that’s one solution that could help. The other key is to make sure the EHR vendor has optimized the login process. It reminds me of when I use to login to a Windows computer. Back in the day you knew to just log it in and then go get some breakfast or coffee while you waited. Windows 10 still isn’t perfect, but it’s gotten way better. I love my Chromebook because it’s nearly instant. We likely need to go through this same progression with EHR logins.
An EHR login seems like such a small thing. Everyone has it and it’s not likely something that you evaluated when you selected your EHR. Yet, as Dr. Schmidt points out, it can add up to a lot of lost money and time.
John,
Agreed with your comments, and I’d like to remind all of us to look at the opposite side of the issue; the time wasted when EHR’s are not used. Go back to the ER I’ve described a few times a couple years ago. Patient comes into ER, gets a quickie triage. Maybe brought in and given a bed quickly in ER – or maybe hours waiting. Once in that bed, eventually a nurse comes around with a clipboard, retakes a few vitals, re-asks all the questions the triage nurse did, writes down answers and results. Puts chart in stack for ER doc. Doc eventually, maybe once per hour, makes his ER rounds, asks the same questions, actually does a quick physical exam as appropriate, writes down his results. At end of rounds, he goes back to a desk, sits, dictates notes, writes up orders for the patients for tests and meds. Eventually someone collects the orders, calls them in to radiology, EKG and the lab. At about the same time for each patient, all 3 techs show up, get in each other’s way, 2 give up and go back, and try again an hour later. An hour or two later, results and views are available at desk for the doctor when he completes his latest rounds. He shuffles all his papers, makes a new set of rounds, this time telling patients he has results for what he plans, eventually gets back to desk and does new sets of orders for all patients from that set of rounds. Eventually meds come up, someone calls floors looking and hoping for beds, a few hours later patient is being treated, and may make it up to floor within, hopefully, 12 hours after arrival. Upstairs, doctors notes and orders take hours more to arrive and be acted on as needed. Hopefully nothing has been lost along the way. Of course, if orders are needed from an outside doctor for the ER or after admission, those can take anywhere from 20 minutes to days to arrive. Worse yet, if tests from another hospital are needed, definitely figure a few days.
Piles of time wasted at every step, lots of mistakes made due to incomplete or misplaced information or misread orders. ER and hospital bed space badly wasted. And its not good for the patient either!
So things are not perfect in EHR world, but done properly they have will continue to improve the medical profession in the years ahead!
Ron
The above may all be true, but I wonder why you only include “physicians” in all of this. The correct term these days is actually “provider,” as many of those providing initial care are not physicians but NPs, APNs, and PAs. They too have to log in and document in an EHR. Not to mention the other HC professionals working in hospital settings such as nurses of all levels, therapists (PTs, Speech Therapists, OTs, etc.), pharmacists, social workers, unit clerks, and so on, who keep the day to day operations in HC settings going. Often, these people can’t even GET access to a workstation when they need to, let alone log in…
Then, there is the perennial problem of inadequate server capacity in larger HC systems, that affects everyone as well.
You might want to look at the very ubiquitous use of WOWs (workstations on wheels) which are in fact smaller computers, laptops primarily, that are mobile and can be used “on the go,” around the hospital ward, by everyone (if someone remembers to recharge them). And what is wrong with tablets and phones, if they help providers to keep in touch throughout the day and do their work? Stationary work stations are not the only option here!