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Monitoring the pulse of hospital activity: Electronic health record utilization as a measure of care intensity

Authors

  • Saul Blecker MD, MHS,

    Corresponding author
    1. Department of Population Health, New York University School of Medicine, New York, New York
    2. Department of Medicine, New York University Langone Medical Center, New York, New York
    • Address for correspondence and reprint requests: Saul Blecker, MD, New York University School of Medicine, 227 E. 30th Street, office 648, New York, NY 10016; Telephone: 646-501-2513; Fax: 646-501-2706; E-mail: saul.blecker@nyumc.org

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  • Jonathan S. Austrian MD,

    1. Department of Medicine, New York University Langone Medical Center, New York, New York
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  • Daniel Shine MD,

    1. Department of Medicine, New York University Langone Medical Center, New York, New York
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  • R. Scott Braithwaite MD, MSc,

    1. Department of Population Health, New York University School of Medicine, New York, New York
    2. Department of Medicine, New York University Langone Medical Center, New York, New York
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  • Martha J. Radford MD,

    1. Department of Medicine, New York University Langone Medical Center, New York, New York
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  • Marc N. Gourevitch MD, MPH

    1. Department of Population Health, New York University School of Medicine, New York, New York
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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. Journal of Hospital Medicine 2013;8:513–518. © 2013 Society of Hospital Medicine

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