Monitoring the pulse of hospital activity: Electronic health record utilization as a measure of care intensity
Article first published online: 31 JUL 2013
Copyright © 2013 Society of Hospital Medicine
Journal of Hospital Medicine
Volume 8, Issue 9, pages 513–518, September 2013
How to Cite
Blecker, S., Austrian, J. S., Shine, D., Braithwaite, R. S., Radford, M. J. and Gourevitch, M. N. (2013), Monitoring the pulse of hospital activity: Electronic health record utilization as a measure of care intensity. J. Hosp. Med., 8: 513–518. doi: 10.1002/jhm.2068
- Issue published online: 6 SEP 2013
- Article first published online: 31 JUL 2013
- Manuscript Accepted: 30 MAY 2013
- Manuscript Revised: 9 MAY 2013
- Manuscript Received: 6 FEB 2013
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).
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.
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).
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. Journal of Hospital Medicine 2013;8:513–518. © 2013 Society of Hospital Medicine