Abstract
Objective: The purpose of this study was to evaluate the variations in electronic health record (EHR) activity among General and Specialty pediatricians by investigating the time spent and documentation length, normalized for workload.Materials and Methods: We conducted a cross-sectional study of pediatric physicians using Epic EHR at a major Southeastern academic healthcare system. We collected user-level EHR activity data of 104 pediatric physicians over 91 days from April 1 to June 30, 2020.Results: Of the 104 pediatrics physicians, 56 (54%) were General pediatricians and 48 (46%) were Specialists pediatricians. General pediatricians spent an average of 17.6 min [interquartile range (IQR): 12.9–37] using the EHR per appointment, while Specialists spent 35.7 min (IQR: 28–48.4) per appointment.Significant negative associations were found between proficiency scores and the amount of time spent in the system for Generalists (p < 0.001). On the contrary, significant positive associations were found between proficiency scores and the amount of time spent in the system for Specialists (p < 0.01).Conclusions: We report an association between EHR proficiency and efficiency levels among pediatricians within the same healthcare system, receiving the same EHR training, and using the same EHR system. The profound differences in EHR activity suggest that higher priority should be given to redesigning EHR training methods to accommodate the learning needs of physicians.
Highlights
Electronic health record (EHR) use is associated with physician burnout and fatigue [1, 2]
This study demonstrates that a wide gap in EHR usability exists between pediatricians within the same healthcare system, FIGURE 2 | Distribution of time spent in the EHR system per appointment among the most and least efficient General and Specialist pediatricians
Generalist pediatricians typically practice in primary care clinics where the type of care provided is usually repetitious and direct, which explains why higher EHR proficiency was associated with less time in the system
Summary
Electronic health record (EHR) use is associated with physician burnout and fatigue [1, 2]. Burnout is associated with more EHR time outside clinic hours, known as pajama time [5], more clinical documentation [6, 7], lower same-day chart completion, longer completion time for inbox messages, and incomplete inbox messages [5,6,7]. Primary care physicians spend an average of 190 min per day on documentation alone, with documentation being the primary task both in clinic and remotely [7] On average, physicians spend 1–2 h outside of working hours on EHR work [8]. Burnedout providers spend an additional 10 min per appointment after-hours working in the EHR compared with non-burned-out colleagues [2, 3, 9]
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