{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,6]],"date-time":"2026-05-06T05:28:54Z","timestamp":1778045334597,"version":"3.51.4"},"reference-count":22,"publisher":"Oxford University Press (OUP)","issue":"1","license":[{"start":{"date-parts":[[2017,9,26]],"date-time":"2017-09-26T00:00:00Z","timestamp":1506384000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"funder":[{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["P30 EY010572 and K99LM012238"],"award-info":[{"award-number":["P30 EY010572 and K99LM012238"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2018,1,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Objective<\/jats:title>\n                  <jats:p>Outpatient clinics lack guidance for tackling modern efficiency and productivity demands. Workflow studies require large amounts of timing data that are prohibitively expensive to collect through observation or tracking devices. Electronic health records (EHRs) contain a vast amount of timing data \u2013 timestamps collected during regular use \u2013 that can be mapped to workflow steps. This study validates using EHR timestamp data to predict outpatient ophthalmology clinic workflow timings at Oregon Health and Science University and demonstrates their usefulness in 3 different studies.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Materials and Methods<\/jats:title>\n                  <jats:p>Four outpatient ophthalmology clinics were observed to determine their workflows and to time each workflow step. EHR timestamps were mapped to the workflow steps and validated against the observed timings.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>The EHR timestamp analysis produced times that were within 3\u2009min of the observed times for\u2009&amp;gt;80% of the appointments. EHR use patterns affected the accuracy of using EHR timestamps to predict workflow times.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Discussion<\/jats:title>\n                  <jats:p>EHR timestamps provided a reasonable approximation of workflow and can be used for workflow studies. They can be used to create simulation models, analyze EHR use, and quantify the impact of trainees on workflow.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>The secondary use of EHR timestamp data is a valuable resource for clinical workflow studies. Sample timestamp data files and algorithms for processing them are provided and can be used as a template for more studies in other clinical specialties and settings.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/jamia\/ocx098","type":"journal-article","created":{"date-parts":[[2017,8,29]],"date-time":"2017-08-29T03:11:23Z","timestamp":1503976283000},"page":"40-46","source":"Crossref","is-referenced-by-count":46,"title":["Secondary use of electronic health record data for clinical workflow analysis"],"prefix":"10.1093","volume":"25","author":[{"given":"Michelle R","family":"Hribar","sequence":"first","affiliation":[{"name":"Department of Medical Informatics and Clinical Epidemiology, Oregon Health and Science University, Portland, OR, USA"}]},{"given":"Sarah","family":"Read-Brown","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, Casey Eye Institute, Oregon Health and Science University, Portland, OR, USA"}]},{"given":"Isaac H","family":"Goldstein","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, Casey Eye Institute, Oregon Health and Science University, Portland, OR, USA"}]},{"given":"Leah G","family":"Reznick","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, Casey Eye Institute, Oregon Health and Science University, Portland, OR, USA"}]},{"given":"Lorinna","family":"Lombardi","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, Casey Eye Institute, Oregon Health and Science University, Portland, OR, USA"}]},{"given":"Mansi","family":"Parikh","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, Casey Eye Institute, Oregon Health and Science University, Portland, OR, USA"}]},{"given":"Winston","family":"Chamberlain","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, Casey Eye Institute, Oregon Health and Science University, Portland, OR, USA"}]},{"given":"Michael F","family":"Chiang","sequence":"additional","affiliation":[{"name":"Department of Medical Informatics and Clinical Epidemiology, Oregon Health and Science University, Portland, OR, USA"},{"name":"Department of Ophthalmology, Casey Eye Institute, Oregon Health and Science University, Portland, OR, USA"}]}],"member":"286","published-online":{"date-parts":[[2017,9,26]]},"reference":[{"key":"2020110612453294800_ocx098-B1","doi-asserted-by":"crossref","first-page":"275","DOI":"10.1056\/NEJMhpr1405667","article-title":"Health care coverage under the Affordable Care Act: a progress report","volume":"371","author":"Blumenthal","year":"2014","journal-title":"N Engl J Med."},{"key":"2020110612453294800_ocx098-B2","doi-asserted-by":"crossref","first-page":"606","DOI":"10.1097\/00005650-200207000-00007","article-title":"Effects of managed care on the length of time that elderly patients spend with physicians during ambulatory visits: National Ambulatory Medical Care Survey","volume":"40","author":"Hu","year":"2002","journal-title":"Med Care."},{"key":"2020110612453294800_ocx098-B3","doi-asserted-by":"crossref","first-page":"192","DOI":"10.1056\/NEJMp0910140","article-title":"Accelerating the use of electronic health records in physician practices","volume":"362","author":"Shea","year":"2010","journal-title":"N Engl J Med."},{"key":"2020110612453294800_ocx098-B4","doi-asserted-by":"crossref","first-page":"1591","DOI":"10.1016\/j.ophtha.2008.03.024","article-title":"Adoption and perceptions of electronic health record systems by ophthalmologists: an American Academy of Ophthalmology survey","volume":"115","author":"Chiang","year":"2008","journal-title":"Ophthalmology."},{"key":"2020110612453294800_ocx098-B5","doi-asserted-by":"crossref","first-page":"1702","DOI":"10.1016\/j.ophtha.2013.04.029","article-title":"Adoption of electronic health records and preparations for demonstrating meaningful use: an American Academy of Ophthalmology survey","volume":"120","author":"Boland","year":"2013","journal-title":"Ophthalmology."},{"key":"2020110612453294800_ocx098-B6","first-page":"34","article-title":"Evaluation of electronic health record implementation in ophthalmology at an academic medical center (an American Ophthalmology Society thesis)","volume":"111","author":"Chiang","year":"2013","journal-title":"Trans Am Ophthalmol Soc."},{"key":"2020110612453294800_ocx098-B7","first-page":"1655","article-title":"Wait time as a driver of overall patient satisfaction in an ophthalmology clinic","volume":"7","author":"McMullen","year":"2013","journal-title":"Clin Ophthalmol"},{"key":"2020110612453294800_ocx098-B8","doi-asserted-by":"crossref","first-page":"6542","DOI":"10.1167\/iovs.13-12108","article-title":"Patient-related and system-related barriers to glaucoma follow-up in a county hospital population","author":"Lee","year":"2013","journal-title":"Invest Ophthalmol Vis Sci."},{"key":"2020110612453294800_ocx098-B9","doi-asserted-by":"crossref","first-page":"2574076","DOI":"10.1155\/2016\/2574076","article-title":"A patient flow analysis: identification of process inefficiencies and workflow metrics at an ambulatory endoscopy unit","volume":"2016","author":"Almeida","year":"2016","journal-title":"Can J Gastroenterol Hepatol."},{"key":"2020110612453294800_ocx098-B10","doi-asserted-by":"crossref","first-page":"594","DOI":"10.1002\/lary.24848","article-title":"Electronic health records and resident workflow: a time-motion study of otolaryngology residents","volume":"125","author":"Victores","year":"2015","journal-title":"The Laryngoscope."},{"key":"2020110612453294800_ocx098-B11","doi-asserted-by":"crossref","first-page":"292","DOI":"10.1016\/j.jbi.2014.02.017","article-title":"Time motion studies in healthcare: what are we talking about?","volume":"49","author":"Lopetegui","year":"2014","journal-title":"J Biomed Inform."},{"key":"2020110612453294800_ocx098-B12","first-page":"768","article-title":"Process visibility analysis in ambulatory care: a simulation study with RFID data","volume":"192","author":"Lin","year":"2013","journal-title":"Stud Health Technol Inform."},{"key":"2020110612453294800_ocx098-B13","doi-asserted-by":"crossref","first-page":"3507","DOI":"10.1007\/s10916-011-9789-8","article-title":"The adoption and implementation of RFID technologies in healthcare: a literature review","volume":"36","author":"Yao","year":"2012","journal-title":"J Med Syst."},{"key":"2020110612453294800_ocx098-B14","doi-asserted-by":"crossref","first-page":"32","DOI":"10.1186\/s12942-015-0023-7","article-title":"A comparison of commercial and custom-made electronic tracking systems to measure patient flow through an ambulatory clinic","volume":"14","author":"Vakili","year":"2015","journal-title":"Int J Health Geogr."},{"key":"2020110612453294800_ocx098-B15","first-page":"1909","article-title":"Secondary use of EHR timestamp data: validation and application for workflow optimization","volume":"2015","author":"Hribar","year":"2015","journal-title":"AMIA Annual Symposium Proceedings."},{"key":"2020110612453294800_ocx098-B16","first-page":"647","article-title":"Clinic workflow simulations using secondary EHR data","volume":"2016","author":"Hribar","year":"2016","journal-title":"AMIA Annual Symposium Proceedings."},{"key":"2020110612453294800_ocx098-B17","doi-asserted-by":"crossref","first-page":"e28","DOI":"10.1093\/jamia\/ocw088","article-title":"The electronic health record audit file: the patient is waiting","volume":"24","author":"Hirsch","year":"2017","journal-title":"J Am Med Inform Assoc."},{"key":"2020110612453294800_ocx098-B18","article-title":"Quantifying the Impact of Trainee Providers on Outpatient Clinic Workflow Using Secondary EHR Data","author":"Goldstein","journal-title":"AMIA Annual Symposium Proceedings"},{"key":"2020110612453294800_ocx098-B19","volume-title":"R: A Language and Environment for Statistical Computing","author":"R Core Team","year":"2016"},{"key":"2020110612453294800_ocx098-B20","author":"Arena Simulation Software","year":"2017"},{"key":"2020110612453294800_ocx098-B21","article-title":"Evaluating and improving an outpatient clinic scheduling template using secondary electronic health record data","volume-title":"AMIA Annual Symposium Proceedings","author":"Hribar"},{"key":"2020110612453294800_ocx098-B22","article-title":"Time requirements for electronic health record use in an academic medical center","author":"Read-Brown","journal-title":"JAMA Ophthalmol"}],"container-title":["Journal of the American Medical Informatics Association"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/academic.oup.com\/jamia\/article-pdf\/25\/1\/40\/34149694\/ocx098.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"http:\/\/academic.oup.com\/jamia\/article-pdf\/25\/1\/40\/34149694\/ocx098.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2020,11,6]],"date-time":"2020-11-06T18:29:50Z","timestamp":1604687390000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/jamia\/article\/25\/1\/40\/4222811"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2017,9,26]]},"references-count":22,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2017,9,26]]},"published-print":{"date-parts":[[2018,1,1]]}},"URL":"https:\/\/doi.org\/10.1093\/jamia\/ocx098","relation":{},"ISSN":["1067-5027","1527-974X"],"issn-type":[{"value":"1067-5027","type":"print"},{"value":"1527-974X","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2018,1]]},"published":{"date-parts":[[2017,9,26]]}}}