Monitoring the pulse of hospital activity

Electronic health record utilization as a measure of care intensity

Saul Blecker, Jonathan S. Austrian, Daniel Shine, R. Scott Braithwaite, Martha J. Radford, Marc Gourevitch

Research output: Contribution to journalArticle

Abstract

BACKGROUND: Hospital care on weekends has been associated with reduced quality and poor clinical outcomes, suggesting that decreases in overall intensity of care may have important clinical effects. We describe a new measure of hospital intensity of care based on utilization of the electronic health record (EHR). METHODS: We measured global intensity of care at our academic medical center by monitoring the use of the EHR in 2011. Our primary measure, termed EHR interactions, was the number of accessions of a patient's electronic record by a clinician, adjusted for hospital census, per unit of time. Our secondary measure was percent of total available central processing unit (CPU) power used to access EHR servers at a given time. RESULTS: EHR interactions were lower on weekend days as compared to weekdays at every hour (P<0.0001), and the daytime peak in intensity noted each weekday was blunted on weekends. The relative rate and 95% confidence interval (CI) of census-adjusted record accessions per patient on weekdays compared with weekends were: 1.76 (95% CI: 1.74-1.77), 1.52 (95% CI: 1.50-1.55), and 1.14 (95% CI: 1.12-1.17) for day, morning/evening, and night hours, respectively. Percent CPU usage correlated closely with EHR interactions (r=0.90). CONCLUSIONS: EHR usage is a valid and easily reproducible measure of intensity of care in the hospital. Using this measure we identified large, hour-specific differences between weekend and weekday intensity. EHR interactions may serve as a useful measure for tracking and improving temporal variations in care that are common, and potentially deleterious, in hospital systems.

Original languageEnglish (US)
Pages (from-to)513-518
Number of pages6
JournalJournal of Hospital Medicine
Volume8
Issue number9
DOIs
StatePublished - Sep 2013

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Electronic Health Records
Confidence Intervals
Censuses

ASJC Scopus subject areas

  • Health Policy
  • Assessment and Diagnosis
  • Care Planning
  • Fundamentals and skills
  • Leadership and Management

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Monitoring the pulse of hospital activity : Electronic health record utilization as a measure of care intensity. / Blecker, Saul; Austrian, Jonathan S.; Shine, Daniel; Braithwaite, R. Scott; Radford, Martha J.; Gourevitch, Marc.

In: Journal of Hospital Medicine, Vol. 8, No. 9, 09.2013, p. 513-518.

Research output: Contribution to journalArticle

Blecker, Saul ; Austrian, Jonathan S. ; Shine, Daniel ; Braithwaite, R. Scott ; Radford, Martha J. ; Gourevitch, Marc. / Monitoring the pulse of hospital activity : Electronic health record utilization as a measure of care intensity. In: Journal of Hospital Medicine. 2013 ; Vol. 8, No. 9. pp. 513-518.
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abstract = "BACKGROUND: Hospital care on weekends has been associated with reduced quality and poor clinical outcomes, suggesting that decreases in overall intensity of care may have important clinical effects. We describe a new measure of hospital intensity of care based on utilization of the electronic health record (EHR). METHODS: We measured global intensity of care at our academic medical center by monitoring the use of the EHR in 2011. Our primary measure, termed EHR interactions, was the number of accessions of a patient's electronic record by a clinician, adjusted for hospital census, per unit of time. Our secondary measure was percent of total available central processing unit (CPU) power used to access EHR servers at a given time. RESULTS: EHR interactions were lower on weekend days as compared to weekdays at every hour (P<0.0001), and the daytime peak in intensity noted each weekday was blunted on weekends. The relative rate and 95{\%} confidence interval (CI) of census-adjusted record accessions per patient on weekdays compared with weekends were: 1.76 (95{\%} CI: 1.74-1.77), 1.52 (95{\%} CI: 1.50-1.55), and 1.14 (95{\%} CI: 1.12-1.17) for day, morning/evening, and night hours, respectively. Percent CPU usage correlated closely with EHR interactions (r=0.90). CONCLUSIONS: EHR usage is a valid and easily reproducible measure of intensity of care in the hospital. Using this measure we identified large, hour-specific differences between weekend and weekday intensity. EHR interactions may serve as a useful measure for tracking and improving temporal variations in care that are common, and potentially deleterious, in hospital systems.",
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