Effect of Telemedicine and the COVID-19 Pandemic on Medical Trainees' Usage of the Electronic Health Record in the Outpatient Setting

Abstract

Objectives: 1) To determine the impact of COVID-19 and the corresponding increase in use of telemedicine on volume, efficiency, and burden of Electronic Health Record (EHR) usage by residents and fellows; and 2) To compare these metrics with those of attending physicians. Materials and Methods: We analyzed eleven metrics from Epic’s Signal Database of outpatient physician user logs for active residents/fellows at our institution across three 1-month time periods: August 2019 (pre-pandemic / pre-telehealth), May 2020 (mid-pandemic / post-telehealth implementation) and July 2020 (follow-up period) and compared these metrics between trainees and attending physicians. We also assessed how the metrics varied for medical trainees in primary care as compared to subspecialties. Results: Analysis of 141 residents/fellows and 495 attendings showed that after telehealth implementation, overall patient volume, Time in In Basket per day, Time Outside of 7AM-7PM, and Time in Notes decreased significantly compared to the pre-telehealth period. Female residents, fellows, and attendings had a lower same day note closure rate before and during the post-telehealth implementation period and spent greater time working outside of 7 AM-7 PM compared to male residents, fellows, and attendings (p<0.01) compared to the pre-telehealth period. Attending physicians had a greater patient volume, spent more time and were more efficient in the EHR compared to trainees (p<0.01) in both the post-telehealth and follow-up periods as compared to the pre-telehealth period. Conclusion: The dramatic change in clinical operations during the pandemic serves as an inflection point to study changes in physician practice patterns via the EHR. We observed that: 1) female physicians closed fewer notes the same day and spent more time in the EHR outside of normal working hours compared to male physicians; and 2) attending physicians had higher patient volumes and also higher efficiency in the EHR compared to resident physicians.