This is a retrospective study of all consecutive patients referred to a cardiologist after preoperative screening in the outpatient anaesthesiology clinic of the Erasmus University Medical Centre, Rotterdam, the Netherlands between November 2011 and January 2014. No ethical approval was required because the study is based on anonymised retrospective data. As per hospital protocol, all patients ≥18 years scheduled for elective non-cardiac surgery are screened by an anaesthesiologist, an anaesthesiologist-in-training or a trained physician assistant

Because electronic medical record systems may affect productivity of clinical practice, we examined the effects of different types of medical record systems on consultation time and total fee claims for outpatient consultation for cardiovascular cases. We investigated consultation time (i.e., the sum of practice time and work-up time) and total fee claims by 13 cardiovascular physicians for 862 outpatients. The means of consultation time and total fee claims were calculated for 3 types of medical records: electronic, paper-based, and hybrid. No difference in mean consultation time was seen between the electronic and paper-based medical record groups (paper based, 11.4±0.3 min/case; electronic, 12.7±0.8 min/case; hybrid, 13.5±0.5 min/case). In contrast, the electronic group had the highest mean practice time (10.9±0.6 min/case) and the lowest mean work-up time (1.7±0.4 min/case). There was no difference in total fee claims between the 3 medical record groups. The total fee claims per practice time was lower for the electronic group than the paper-based (67.5±52.8 vs. 108.8±108.1 points/min, P<0.001). The findings suggest that physicians using the electronic medical record system can be more directly involved with patients due to higher productivity, as reflected in the lower work-up time.