Impact of an electronic information system on physician workflow and data collection in the intensive care unit

Objective: To test the hypotheses that: (1) integrating information processing tasks using an electronic clinical information system (ECIS) decreases time to complete these tasks by hand; and (2) structured data entry encourages generation of more detailed records and capture of specific data elements even when entry is voluntary. Design: Prospective observational time analysis during medical documentation tasks. Retrospective analysis of clinical documentation completed by hand or electronically. Setting: Eleven bed pediatric intensive care unit within an academic medical center. Participants: Five pediatric intensive care medicine attending physicians. Measurements: Compared handwritten and electronic documentation to determine: (1) time spent entering data or composing notes; (2) number of descriptors documenting patients' physical exams; (3) users' preferences for structured or unstructured data entry; (4) frequency of documenting specific data elements related to nutritional support. Results: Documentation time varied by user but not charting method: it took 13% less time to document using the ECIS but this was not significant. Electronic documents were more detailed than handwritten containing 50% more descriptors (17.8 +/- 1.4 vs 11.6 +/- 1.4) overall and some data elements that were not handwritten: information related to nutritional supplementation was recorded in 13% of electronic documents but in none of 89 handwritten documents. Conclusions: Electronic and handwritten documentation consumed equal amounts of time. Structured entry, compared to handwriting, may encourage recording of specific or otherwise unincorporated data elements resulting in a more detailed record. This suggests that user interfaces and decision support components may influence both the types and complexity of clinical. data recorded by caregivers.