Ask the expert: How can we use EHRs to track resident duty hours?

Residency Program Insider, November 15, 2011

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Residents access the EHR system consistently throughout their shifts. Daniel Shine, MD, associate professor and chief of the medicine service at New York University Langone Medical Center in New York City decided to track residents' EHR activity—specifically, when residents' EHR activity ceased for the day—to determine the number of hours a resident worked. If a resident did not access the EHR system for six hours, the system would note the time of the resident's last interaction as the time he or she left work.

"We tested it in the ICU. If you're off the computer for six hours, you're not here," Shine says. "There's no way you can be taking care of patients in the ICU and not consulting a computer in a six-hour period."

Shine compared the data collected via EHR surveillance with the program's previous system for collecting duty hours (time cards) and found that both methods yielded similar data. There was a 7.3% discrepancy in the measurement of total hours worked, but both systems identified the same number of duty hour violations.

Implementing electronic health record (EHR) duty hour monitoring is a two-step process. The first is to work with the EHR team to ensure that the residents' logon/logoff data can be collected in a spreadsheet in a timely manner. This step is very straightforward, says Shine. Most in-hospital EHR personnel will happily work with stakeholders to leverage the system's power. Consider capturing the following interactions residents have with the EHR:

  • Entering orders
  • Viewing results
  • Writing notes
  • Opening notes

The second step, creating the spreadsheet, is the more difficult of the two. "I've got 40,000 lines of data for residents' logging on/off for a full month. It's very simple data, but it's a lot of it," Shine says, adding that the spreadsheet should ­ideally use the data to automatically calculate duty hours and flag violations.
Shine typically downloads the data from the EHR system into the spreadsheet at the end of the rotation block, which makes it close to a monthly process.

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