Electronic Health Record Usage Patterns: Assessing Telemedicine's Impact on the Provider Experience During the COVID-19 Pandemic

Abstract

Telemedicine has been widely implemented during the coronavirus disease 2019 (COVID-19) pandemic; however, its impact on those providing care remains largely understudied. Provider documentation data collected by the electronic health record (EHR) represents an underutilized tool for assessing the provider experience. Through Epic Signal, we collected data regarding the actions logged in the EHR by health care providers of the Montefiore Health System (Bronx, NY) before and after the implementation of telemedicine during the pandemic. Focusing on five metrics (appointments per day, visits closed same day, time spent outside 7 AM-7 PM, time spent on unscheduled days, and pajama time), we performed a preliminary analysis of providers across the institution, by specialty, and according to demographic characteristics such as gender and years since graduation. We observed that after telemedicine implementation, a greater proportion of providers had fewer appointments per day, closed more notes same day, and spent less time in the EHR outside of normal working hours for each of the time-related metrics. We additionally found that providers who graduated longer ago as well as female providers spent more time documenting in the EHR after hours. This brief analysis highlights the potential of using EHR data to inform decisions based on provider well-being, specifically in the setting of telemedicine implementation.

Physician Electronic Health Record Usage as Affected by the COVID-19 Pandemic

“…9 Our prior study compared metrics derived from provider action logs from two time periods (August 2019 and May 2020) to examine differences due to factors relating to the pandemic and the implementation of telemedicine. 3 Our preliminary findings not only identified differences in…”

“…1,2 Physician experience and burden as affected by these unprecedented changes have understandably been a focus of recent studies. [3][4][5][6][7] Surveys of physicians have sought to provide insight on how these changes may impacted work-flow and how that may affect burnout rates. 6,7 However, with the heterogeneity of the target population, given different specialties, practice locations and responsibilities, as well as the often rapidly changing clinical environment, surveys may be too burdensome and lack the granularity needed to fully understand how changes may be affecting physicians.…”

“…patterns. 3,10 We included all attending physicians who were active in the EHR during three 1month periods. August 2019 was selected as the baseline pre-telemedicine implementation period.…”

Designing Call to Action: Users’ Perception of Different Characteristics

“…In hospital environments, specifically in OR's, surgeons and other involved staff such as scrub nurses and circulating nurses use information systems and technological devices to support or execute surgeries. However, possibilities for digitization of supporting activities remain a topic of interest and research continues (Fennelly et al, 2020;Rodriguez Socarrás et al, 2020;Scott et al, 2020;Beiser et al, 2021). The focus of this study was to evaluate an implementation protocol with a case to introduce an exoskeleton for use by scrub and circulating nurses.…”

Frequent and diverse use of electronic health records in the United States: A trend analysis of national surveys

“…First, EHRs can help healthcare institutions to reduce medical costs, track patient data over time, and improve healthcare quality. 4 – 6 Second, access to medical records allows patients to better understand their medical history and health condition, save time and cost, increase access to care, and reduce the inconvenience of travel for medical and administrative purposes. 7 – 9 Such services provided through EHRs can facilitate patient empowerment, which indicates that the role of the patient is shifting from a patronized patient to an engaged and informed patient.…”