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IMPORTANCE Understanding how the electronic health record (EHR) system changes clinician work, productivity, and well-being is critical. Little is known regarding global variation in patterns of use. OBJECTIVE To provide insights into which EHR activities clinicians spend their time doing, the EHR tools they use, the system messages they receive, and the amount of time they spend using the EHR after hours.

BackgroundSepsis remains the top cause of morbidity and mortality of hospitalised patients despite concerted efforts. Clinical decision support for sepsis has shown mixed results reflecting heterogeneous populations, methodologies and interventions.ObjectivesTo determine whether the addition of a real-time electronic health record (EHR)-based clinical decision support alert improves adherence to treatment guidelines and clinical outcomes in hospitalised patients with suspected severe sepsis.DesignPatient-level randomisation, single blinded.SettingMedical and surgical inpatient units of an academic, tertiary care medical centre.Patients1123 adults over the age of 18 admitted to inpatient wards (intensive care units (ICU) excluded) at an academic teaching hospital between November 2014 and March 2015.InterventionsPatients were randomised to either usual care or the addition of an EHR-generated alert in response to a set of modified severe sepsis criteria that included vital signs, laboratory values and physician orders.Measurements and main resultsThere was no significant difference between the intervention and control groups in primary outcome of the percentage of patients with new antibiotic orders at 3 hours after the alert (35% vs 37%, p=0.53). There was no difference in secondary outcomes of in-hospital mortality at 30 days, length of stay greater than 72 hours, rate of transfer to ICU within 48 hours of alert, or proportion of patients receiving at least 30 mL/kg of intravenous fluids.ConclusionsAn EHR-based severe sepsis alert did not result in a statistically significant improvement in several sepsis treatment performance measures.

Objective The COVID-19 pandemic changed clinician electronic health record (EHR) work in a multitude of ways. To evaluate how, we measure ambulatory clinician EHR use in the United States throughout the COVID-19 pandemic. Materials and Methods We use EHR meta-data from ambulatory care clinicians in 366 health systems using the Epic EHR system in the United States from December 2019 to December 2020. We used descriptive statistics for clinician EHR use including active-use time across clinical activities, time after-hours, and messages received. Multivariable regression to evaluate total and after-hours EHR work adjusting for daily volume and organizational characteristics, and to evaluate the association between messages and EHR time. Results Clinician time spent in the EHR per day dropped at the onset of the pandemic but had recovered to higher than prepandemic levels by July 2020. Time spent actively working in the EHR after-hours showed similar trends. These differences persisted in multivariable models. In-Basket messages received increased compared with prepandemic levels, with the largest increase coming from messages from patients, which increased to 157% of the prepandemic average. Each additional patient message was associated with a 2.32-min increase in EHR time per day (P < .001). Discussion Clinicians spent more total and after-hours time in the EHR in the latter half of 2020 compared with the prepandemic period. This was partially driven by increased time in Clinical Review and In-Basket messaging. Conclusions Reimbursement models and workflows for the post-COVID era should account for these demands on clinician time that occur outside the traditional visit.

psychotropic drugs at the onset of the COVID-19 pandemic that persisted through September 2020. Although absolute increases in prescribing were small, they were disproportionate to expected secular prescribing trends from April 2018 to February 2020, and they were distinct from observed prescribing changes for other drugs during the pandemic.This study examined the prescribing patterns of multiple classes of psychotropic drugs as well as drugs for which prescribing patterns were not expected to change during the pandemic. The results thus expand on those of a study in the United Kingdom, which reported increased prescribing of antipsychotic medications among patients with dementia during the pandemic. 3 Our study is limited by a lack of data on prescribing indications. Although psychotropic medications may have been prescribed for residents who were dying of COVID-19, drugs such as antidepressants and trazodone are not typically used for acute palliative management. Therefore, it is likely that prescribing increases were also associated with the consequences of prolonged social isolation produced by infection prevention and control measures. 4,5 Furthermore, clinicians may have been less likely to prioritize favorable nonpharmacological management for common issues, such as responsive behaviors, because of diminished resources, including lack of staffing.Overall, the study's findings highlight the importance of balancing infection prevention and control measures in nursing homes with the well-being of residents during the COVID-19 pandemic. Further studies are warranted to characterize additional factors that may be associated with drug prescribing during the pandemic, including prescriber and nursing home characteristics. 6