Does autotext usage decrease documentation time among resident physicians? A retrospective analysis of EHR usage data

Objective Usage of autotext or “dotphrases” is ubiquitous among provider
workflows in electronic health records (EHRs). Yet little is known about
the impact of these tools in inpatient settings and among resident
physicians. We aimed to evaluate the association between autotext usage
and documentation time among resident physicians in an academic medical
center using the Cerner® EHR. Dataset Description The association between
auto text executions and documentation time per patient seen for 705
resident physicians rotating at a large academic medical center from July
2021 to June 2023 was analyzed via linear regression after controlling for
specialty, post-graduate year (PGY), provider gender, and patient volume.
NOTE: The dataset in this study cannot be shared publicly due to the risk
of identifying subjects who constitute a vulnerable population and may be
known personally to members of the research community (physicians in
training). Inclusion of details of gender, department, and year in
training, which pose a risk of allowing subjects to be identified, is
integral to the analysis of the data, so the data cannot be published in a
meaningful form without these details. Accordingly, a short sample dataset
that retains the data structure but with randomly generated values that
mimic the actual data is provided instead.  The dataset used in
this study was prepared from raw data downloaded from the Cerner Lightson
and Cerner Advance toolkits and aggregated at the level of an individual
resident physician over an academic year. As the study covers two academic
years, 2021-2022 and 2022-2023, there are two entries for some resident
physicians who were at the institution during both academic
years.  The dataset includes a randomly generated anonymous
identifier for each provider, as well as demographics on department,
gender, and PGY, and data on autotext usage, patient volume, documentation
time per patient seen, and total EHR time per patient seen. Results There
was no significant overall association between autotext executions per
patient seen and documentation time per patient seen in specialties using
Dynamic Documentation as their primary workflow (β=-0.1 min per autotext
execution per patient seen, 95% CI -0.6 to 0.5 min, p=0.79).
However, there was increased documentation time among residents with no
autotext usage compared to residents who used autotext, and this effect
was mediated by the use of personalized autotexts. Specialty, PGY, gender,
and patient volume were significant determinants of documentation time.
Discussion Efforts to decrease documentation time among resident
physicians should encourage autotext adoption but should not be focused on
the promotion of autotext usage alone. Further research should address the
questions of identifying other determinants of documentation time,
autotext design standards, and how autotext usage affects measures of note
quality. Conclusion Autotext adoption decreases documentation time among
resident physicians, but among those who adopt autotext, higher levels of
usage show no benefit.