Accepted for/Published in: JMIR Human Factors
Date Submitted: Feb 22, 2019
Date Accepted: Jul 19, 2019
Factors Associated with After-hours Electronic Health Record Usage among Primary Care Physicians
ABSTRACT
Background:
There is limited published data on variation in physician usage of Electronic Health Records (EHR), particularly after-hours. Research in this area could provide insight into the effects of EHR-related workload on physicians.
Objective:
We sought to examine factors associated with after-hours EHR usage among primary care physicians.
Methods:
Electronic health records usage information was collected on physicians in a large United States hospital. Inclusion criteria consisted of being a primary care physician who started employment with the hospital before the study period. All eligible primary care physicians were included without sampling. Mixed effect statistical modeling was used to investigate the effect of age, gender, workload, normal-hour usage, week-to-week variation, and provider-to-provider variation on the after-hour usage of EHR.
Results:
There was a total of 3,498 weekly records from 50 physicians (22% male; 78% female). Overall, more EHR usage during normal work hours was associated with decreased after-hours usage. The more RVUs generated by physicians, the more time they spent interacting with EHRs - both after hours (???? = 0.04, P <0.001) and total usage time (i.e., during regular and after hours) (???? = 0.24, P <0.001). Gender was associated with total usage time, with females spending more time than males (P = .03). However, this association was not observed with after-hours EHR usage. Provider-to-provider variation was the largest and dominant source of variation in after-hour EHR usage, which accounted for 52% of variance of total EHR usage.
Conclusions:
The present study found that there is considerable amount of variability in EHR use among primary care physicians and suggested that many factors influence after-hours EHR usage by physicians. Provider-to-provider variation was the largest and dominant source of variation in after-hour EHR usage. While the results are intuitive, future studies should consider the effect of variations in EHR use on workload efficiency.
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