Characterizing physician EHR use with vendor derived data: a feasibility study and cross-sectional analysis

Objective: To derive 7 proposed core electronic health record (EHR) use metrics across 2 healthcare systems with different EHR vendor product installations and examine factors associated with EHR time. Materials and Methods: A cross-sectional analysis of ambulatory physicians EHR use across the Yale-New Haven and MedStar Health systems was performed for August 2019 using 7 proposed core EHR use metrics normalized to 8 hours of patient scheduled time. Results: Five out of 7 proposed metrics could be measured in a population of nonteaching, exclusively ambulatory physicians. Among 573 physicians (Yale-New Haven N =290, MedStar N = 283) in the analysis, median EHR-Time 8 was 5.23 hours. Gender, additional clinical hours scheduled, and certain medical specialties were associated with EHR-Time 8 after adjusting for age and health system on multivariable analysis. For every 8 hours of scheduled patient time, the model predicted these differences in EHR time (P< .001, unless otherwise indicated): female physicians +0.58 hours; each additional clinical hour scheduled per month -0.01 hours; practicing cardiology -1.30 hours; medical subspecialties -0.89 hours (except gastroenterology, P= .002); neurology/ psychiatry -2.60 hours; obstetrics/gynecology -1.88 hours; pediatrics -1.05 hours (P= .001); sports/physical medicine and rehabilitation -3.25 hours; and surgical specialties -3.65 hours. Conclusions: For every 8 hours of scheduled patient time, ambulatory physicians spend more than 5 hours on the EHR. Physician gender, specialty, and number of clinical hours practicing are associated with differences in EHR time. While audit logs remain a powerful tool for understanding physician EHR use, additional transparency, granularity, and standardization of vendor-derived EHR use data definitions are still necessary to standardize EHR use measurement.

Automated summary

This study derived 7 core EHR use metrics across 2 healthcare systems and found that factors such as gender, additional clinical hours scheduled, and medical specialties were associated with EHR time. The study also revealed that ambulatory physicians spend over 5 hours on the EHR for every 8 hours of scheduled patient time, highlighting the need for standardization and transparency in EHR use measurement.