S1480 Clinical Burden of Electronic Health Record Use Amongst Gastroenterology Providers Associated With Differences in Sex, Provider Subspecialty, and Provider Training

Abstract

Introduction: The electronic health record (EHR) has increased time spent outside of face-to-face encounters, with higher EHR burden associated with differences in provider sex, specialty, and rates of burnout. However, the EHR burden specific to gastroenterology (GI) providers is not fully understood. Methods: Measures of EHR use calculated through Epic Systems were retrospectively collected for GI providers from a tertiary referral center during a 6-month period starting January 1, 2021. Primary measures used to characterize EHR use included time spent performing clinical review, documentation, and in-basket management as well as quantification of efficiency, messaging, and time logged into the EHR, including time outside regularly scheduled hours (5:30 p.m. to 7:00 a.m. and weekends). EHR use patterns were compared across provider sex, sub-specialty (inflammatory bowel disease [IBD], motility/irritable bowel syndrome, advanced endoscopy [AE], and esophagus [ESO]), and training (physician vs non-physician provider [NPP]). Data was analyzed in aggregate using t-tests and analysis of variance with post-hoc Boniferri correction. Results: Data from 33 providers compromising 3,743 clinic days and 16,572 appointments was collected. Overall, 69.7% (23/33) were physicians, 30.3% (10/33) NPPs and 48.5% (16/33) were women, with women comprising all NPPs. Comparing EHR burden across sexes, women spent more daily time in clinical review than men (42.4 minutes vs 26.0, P = 0.02), though this result lost statistical significance when excluding NPPs. Comparing sub-specialties, IBD specialists spent more daily time in clinical review per appointment than AEs or ESOs (13.7 minutes vs 3.9 and 3.7, respectively; P < 0.001) yet had higher efficiency scores compared to these sub-specialties (P < 0.001). Compared to AEs, IBD specialists spent more overall daily time in the EHR (131.5 minutes vs 39.7, P < 0.005) as well as more daily time outside of regular work hours (60.0 minutes vs 8.9, P < 0.01). Comparing provider training, NPPs spent more daily time in the in-basket (P = 0.03), clinical review (P = 0.02), and overall EHR (P < 0.001) than physicians. Additionally, NPPs received more patient medical advice request messages per day than physicians (P = 0.03). Conclusion: IBD specialists and NPPs have an increased EHR burden. More work is needed to better understand sex, sub-specialty, and training-based differences in workload to combat factors contributing to provider burnout.