JMIR Publications

ABSTRACT

Background:

Many of the benefits of electronic health records (EHRs) have not been achieved at expected levels due to a variety of unintended negative consequences such as documentation burden. Previous studies have characterized EHR use during and outside work hours, with many reporting physicians spending considerable time on documentation-related tasks. These studies characterized EHR use during and outside work hours using clock time versus actual physician clinic schedules to define outside work time.

Objective:

This study characterizes EHR work outside scheduled clinic hours among primary care pediatricians using a retrospective descriptive task analysis of EHR access log data and actual physician clinic schedules to define work time.

Methods:

A retrospective exploratory descriptive task analysis of EHR access log data from primary care pediatricians in September 2019 at a large midwestern pediatric health center was conducted to quantify and identify actions completed outside scheduled clinic hours. Mixed effects statistical modeling was used to investigate the effects of age, sex, clinical full-time equivalent status, and EHR work during scheduled clinic hours on the use of EHRs outside scheduled clinic hours.

Results:

Primary care pediatricians (n=56) in this study generated a total of 1,523,872 access-log data points (across 1,069 physician workdays) and spent an average of 4.4 and 0.8 hours per physician per workday engaged in the EHR during and outside scheduled clinic hours, respectively. About three-quarters of the time working in the EHR during or outside scheduled clinic hours was spent reviewing data and reports. Mixed effects regression revealed no associations of age, sex, nor clinical full-time equivalent status with EHR use during or outside scheduled clinic hours.

Conclusions:

For every hour primary care pediatricians in this study spent engaged with the EHR during scheduled clinic hours, they spent about 10 minutes interacting with the EHR outside scheduled clinic hours. Most of their time (both during and outside of scheduled clinic hours) was spent reviewing data, records, and other information in the EHR.