Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 May 12;10(5):e34787.
doi: 10.2196/34787.

Characterization of Electronic Health Record Use Outside Scheduled Clinic Hours Among Primary Care Pediatricians: Retrospective Descriptive Task Analysis of Electronic Health Record Access Log Data

Selasi Attipoe  1 , Jeffrey Hoffman  2   3 , Steve Rust  4 , Yungui Huang  4 , John A Barnard  3   4 , Sharon Schweikhart  1 , Jennifer L Hefner  1   5 , Daniel M Walker  5   6 , Simon Linwood  4
Affiliations

Characterization of Electronic Health Record Use Outside Scheduled Clinic Hours Among Primary Care Pediatricians: Retrospective Descriptive Task Analysis of Electronic Health Record Access Log Data

Selasi Attipoe et al. JMIR Med Inform. .

Abstract

Background: Many of the benefits of electronic health records (EHRs) have not been achieved at expected levels because of a variety of unintended negative consequences such as documentation burden. Previous studies have characterized EHR use during and outside work hours, with many reporting that physicians spend 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 the outside work time.

Objective: This study aimed to characterize 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: We conducted 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 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 1,523,872 access log data points (across 1069 physician workdays) and spent an average of 4.4 (SD 2.0) hours and 0.8 (SD 0.8) hours per physician per workday engaged in EHRs during and outside scheduled clinic hours, respectively. Approximately three-quarters of the time working in EHR during or outside scheduled clinic hours was spent reviewing data and reports. Mixed-effects regression revealed no associations of age, sex, or clinical full-time equivalent status with EHR use during or outside scheduled clinic hours.

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

Keywords: access log analysis; electronic health records; pediatrics; primary care physicians; work outside scheduled clinic hours; work outside work.

PubMed Disclaimer

Conflict of interest statement

Conflicts of Interest: None declared.

Figures

Figure 1
Figure 1
Flow chart of data acquisition and data preparation. EHR: electronic health record; RVU: relative value unit.
Figure 2
Figure 2
Histogram of average time spent in the electronic health record (EHR) by each physician outside scheduled clinic hours.
See this image and copyright information in PMC

References

    1. Fletcher KE, Visotcky AM, Slagle JM, Tarima S, Weinger MB, Schapira MM. The composition of intern work while on call. J Gen Intern Med. 2012 Nov;27(11):1432–7. doi: 10.1007/s11606-012-2120-7. http://europepmc.org/abstract/MED/22865015 - DOI - PMC - PubMed
    1. Oxentenko AS, Manohar CU, McCoy CP, Bighorse WK, McDonald FS, Kolars JC, Levine JA. Internal medicine residents' computer use in the inpatient setting. J Grad Med Educ. 2012 Dec;4(4):529–32. doi: 10.4300/JGME-D-12-00026.1. http://europepmc.org/abstract/MED/24294435 JGME-D-12-00026 - DOI - PMC - PubMed
    1. Carayon P, Wetterneck TB, Alyousef B, Brown RL, Cartmill RS, McGuire K, Hoonakker PL, Slagle J, Van Roy KS, Walker JM, Weinger MB, Xie A, Wood KE. Impact of electronic health record technology on the work and workflow of physicians in the intensive care unit. Int J Med Inform. 2015 Aug;84(8):578–94. doi: 10.1016/j.ijmedinf.2015.04.002. http://europepmc.org/abstract/MED/25910685 S1386-5056(15)00079-9 - DOI - PMC - PubMed
    1. Oxentenko AS, West CP, Popkave C, Weinberger SE, Kolars JC. Time spent on clinical documentation: a survey of internal medicine residents and program directors. Arch Intern Med. 2010 Feb 22;170(4):377–80. doi: 10.1001/archinternmed.2009.534.170/4/377 - DOI - PubMed
    1. Sinsky C, Colligan L, Li L, Prgomet M, Reynolds S, Goeders L, Westbrook J, Tutty M, Blike G. Allocation of physician time in ambulatory practice: a time and motion study in 4 specialties. Ann Intern Med. 2016 Dec 06;165(11):753–60. doi: 10.7326/M16-0961.2546704 - DOI - PubMed

LinkOut - more resources