Characterizing physician EHR use with vendor derived data: a feasibility study and cross-sectional analysis

Melnick, Edward R.; Ong, Stephanie L.; Fong, Allan; Socrates, Vimig; Ratwani, Raj M.; Nath, Bidisha; Simonov, Michael; Salgia, Anup; Williams, Brian; Marchalik, Daniel; Goldstein, Richard; Sinsky, Christine A.

doi:10.1093/jamia/ocab011

Cited by 44 publications

(64 citation statements)

References 37 publications

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“…In an era of increasing EHR use measurement and optimization, it is important to examine the factors affecting academic otolaryngologist EHR use. 16 This study examined the relationship between resident coverage in clinic and attending otolaryngologist EHR use. Increasing resident clinic coverage was significantly associated with reduced attending EHR use, with much of this reduction appearing to be due to assistance with note writing.…”

Section: Discussionmentioning

confidence: 99%

“…11,15 A new field of EHR use measurement is developing as a means of improving EHR workflow, as well as measuring clinician efficiency and productivity. 16 One avenue to better understand clinician EHR use is analyzing the data, timestamps, and logs automatically collected by many electronic systems. 11,14,17,18 The international EHR vendor Epic (Epic Systems Corporation, Verona, Wisconsin) collects data on user interactions with the EHR, which is compiled into a provider efficiency profile (PEP).…”

Section: Introductionmentioning

confidence: 99%

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Otolaryngology resident clinic participation and attending electronic health record efficiency—A user activity logs study

Wandell

Giliberto

2021

Laryngoscope Investig Oto

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Objectives: In an era of increasing electronic health record (EHR) use monitoring and optimization, this study aims to quantify resident contributions and measure the effect of otolaryngology resident coverage in clinic on attending otolaryngologist EHR usage. Methods:In one academic otolaryngology department, monthly attending provider efficiency profile metrics, data collected by the EHR vendor (Epic Systems Corporation) between January and June 2019 were accessed. Using weekly resident schedules, resident coverage of attending outpatient clinics was categorized by junior (post-graduate year [PGY] 1-3) and senior levels (PGY-4 through fellows) and correlated with attending EHR metrics using linear mixed effect models.Results: Thirteen attending otolaryngologists on average spent 58.8 minutes per day interacting with the EHR. In modeling, one day of trainee clinic coverage was associated with a 22 minutes reduction (95% CI [À37, À6]) in total daily attending EHR time and a 12 minutes reduction (95% CI [À21, À3]) in per day note time (P < .05). When stratifying by trainee level, senior coverage was associated with significantly reduced total daily time in EHR, per day time in clinical review, notes, and orders, as well as per appointment time in notes and clinical review (P < .05). Junior coverage was only associated with reduced per day note time (P < .05).Conclusions: Increasing resident clinic coverage was inversely related to attending time spent in the EHR and writing notes. Resident contributions to EHR workflows and hospital system productivity should continue to be studied and considered in EHR use measurement studies.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Otolaryngology resident clinic participation and attending electronic health record efficiency—A user activity logs study

Wandell

Giliberto

2021

Laryngoscope Investig Oto

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“…12,13 Time motion studies and EHR log records have indicated an increase in time allocated for desktop medicine with physicians spending nearly 2 hours in the EHR and on other desk work for every hour of direct patient care. 11,[14][15][16][17][18] This perhaps contributes to overflow of EHR work into the physician's nonclinical and personal time, negatively affecting work-life balance. 19 There is accumulating evidence indicating the association of EHR use after work hours with occupational distress including burnout.…”

Section: Background and Significancementioning

confidence: 99%

Novel Nonproprietary Measures of Ambulatory Electronic Health Record Use Associated with Physician Work Exhaustion

et al. 2021

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Background Accumulating evidence indicates an association between physician electronic health record (EHR) use after work hours and occupational distress including burnout. These studies are based on either physician perception of time spent in EHR through surveys which may be prone to bias or by utilizing vendor-defined EHR use measures which often rely on proprietary algorithms that may not take into account variation in physician's schedules which may underestimate time spent on the EHR outside of scheduled clinic time. The Stanford team developed and refined a nonproprietary EHR use algorithm to track the number of hours a physician spends logged into the EHR and calculates the Clinician Logged-in Outside Clinic (CLOC) time, the number of hours spent by a physician on the EHR outside of allocated time for patient care. Objective The objective of our study was to measure the association between CLOC metrics and validated measures of physician burnout and professional fulfillment. Methods Physicians from adult outpatient Internal Medicine, Neurology, Dermatology, Hematology, Oncology, Rheumatology, and Endocrinology departments who logged more than 8 hours of scheduled clinic time per week and answered the annual wellness survey administered in Spring 2019 were included in the analysis. Results We observed a statistically significant positive correlation between CLOC ratio (defined as the ratio of CLOC time to allocated time for patient care) and work exhaustion (Pearson's r = 0.14; p = 0.04), but not interpersonal disengagement, burnout, or professional fulfillment. Conclusion The CLOC metrics are potential objective EHR activity-based markers associated with physician work exhaustion. Our results suggest that the impact of time spent on EHR, while associated with exhaustion, does not appear to be a dominant factor driving the high rates of occupational burnout in physicians.

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“…24 Five of these metrics could be implemented for ambulatory, nonteaching physicians in 2 health care systems operating different EHR vendor products. 22 To our knowledge, no previous studies have examined physician productivity and EHR use patterns and their association with physician turnover. Therefore, we conducted a study of ambulatory physicians' turnover across an ambulatory care delivery network over a 2-year period to determine the association of physicians' productivity and EHR use patterns with departure.…”

Section: Introductionmentioning

confidence: 99%

Analysis of Electronic Health Record Use and Clinical Productivity and Their Association With Physician Turnover

et al. 2021

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IMPORTANCEPhysician turnover takes a heavy toll on patients, physicians, and health care organizations. Survey research has established associations of electronic health record (EHR) use with professional burnout and reduction in professional effort, but these findings are subject to response fatigue and bias. OBJECTIVE To evaluate the association of physician productivity and EHR use patterns, as determined by vendor-derived EHR use data platforms, with physician turnover. DESIGN, SETTING, AND PARTICIPANTS This retrospective cohort study was conducted among nonteaching ambulatory physicians at a large ambulatory practice network based in New England. Data were collected from March 2018 to February 2020. MAIN OUTCOMES AND MEASURES Physician departure from the practice network; 4 time-based core measures of EHR use, normalized to 8 hours of scheduled clinical time; teamwork, percentage of a physician's orders that are placed by other members of the care team; and productivity measures of patient volume, intensity, and demand. RESULTSAmong 335 physicians assessed for eligibility, 314 unique physicians (89.2%) were included in the analysis (123 [39%] women; 100 [32%] aged 45-54 years), with 5663 physicianmonths of data. The turnover rate was 5.1%/year (32 of 314 physicians). Physicians completed a mean 2.6 appointments/hour (95% CI, 2.5-2.6 appointments/hour) and 206 appointments/month (95% CI, 197-215 appointments/month) with 5.5 hours (95% CI, 5.3-5.8 hours) of EHR time for every 8 hours of scheduled patient time. After controlling for gender, medical specialty, and time, the following variables were associated with turnover: inbox time (odds ratio [OR], 0.70; 95% CI, 0.61-0.82; P < .001), teamwork (OR, 0.68; 95% CI, 0.52-0.87; P = .003), demand (ie, proportion of available appointments filled: OR, 0.49; 95% CI, 0.35-0.70; P < .001), and age 45 to 54 years vs 25 to 34 years (OR, 0.19; 95% CI, 0.04-0.93; P = .04). CONCLUSIONS AND RELEVANCEIn this study, physician productivity and EHR use metrics were associated with physician departure. Prospectively tracking these metrics could identify physicians at high risk of departure who would benefit from early, team-based, targeted interventions. The counterintuitive finding that less time spent on the EHR (in particular inbox management) was associated with physician departure warrants further investigation.

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Characterizing physician EHR use with vendor derived data: a feasibility study and cross-sectional analysis

Cited by 44 publications

References 37 publications

Otolaryngology resident clinic participation and attending electronic health record efficiency—A user activity logs study

Otolaryngology resident clinic participation and attending electronic health record efficiency—A user activity logs study

Novel Nonproprietary Measures of Ambulatory Electronic Health Record Use Associated with Physician Work Exhaustion

Analysis of Electronic Health Record Use and Clinical Productivity and Their Association With Physician Turnover

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