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Editors Selection IGR 16-4

Miscellaneous: Electronic Health records

Comment by Shan Lin on:

53125 The impact of an electronic health record transition on a glaucoma subspecialty practice, Pandit RR; Boland MV, Ophthalmology, 2013; 120: 753-760

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Pandit and Boland have conducted a case-control study of patients who were seen before transition to electronic health records (EHR) in an academic glaucoma service compared to those seen after the switch. The time points were two weeks prior to the transition, and two weeks and six months after the implementation. They found that the time spent with a given patient, including on computer-related tasks, significantly increased after the transition. Overall, patients did not perceive a substantial difference in their wait times or interactions with the physicians. Also there was no significant change in the patient volumes between the 12 months before and after the adoption of EHR.

It should be made clear to the clinician considering a switchover to EHR that this study involved a transition from a 'hybrid' computer/ paper system in which physicians were already typing in their notes as free text for printout and future reference. Many, if not most, clinics would be transitioning from a paper chart system to EHR. It is likely that this greater change in clinical practice would have more challenges in the transition process.

Also the authors did not directly address the issue of data management related to testing, such as visual fields and optic nerve/retinal nerve fiber layer analyzers. Usually access to these tests is provided by different software systems requiring a separate purchase, login, and IT support. The additional time spent on this aspect may need to be addressed in future studies.

Finally in the Discussion, it is pointed out that an explanation for the apparent discrepancy in the findings of more time spent with patients and yet same number of patients seen overall, is that the clinicians changed from completing their notes in the absence of patients to during the examination with the switch to EHR. This change in habit may explain much of the results including the increase in time spent with patients.

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