Characterization of EHR Use Outside Work Hours among Primary Care Pediatricians Using Electronic Health Record Access Logs (Preprint)

BACKGROUND Many of the benefits of electronic health records (EHRs) have not been achieved at expected levels due to a variety of unintended negative consequences such as documentation burden. Previous studies have characterized EHR use during and outside work hours, with many reporting physicians spending considerable time on documentation-related tasks. These studies characterized EHR use during and outside work hours using clock time versus actual physician schedules to define outside work time. OBJECTIVE This study closes a knowledge gap by characterizing EHR engagement outside work hours using actual physician schedules to define EHR work outside work hours. METHODS 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 was conducted to quantify and identify actions completed outside work hours. Mixed effects statistical modeling was used to investigate the effects of age, sex, clinical full-time equivalent status, and EHR engagement during work hours on the use of EHRs outside work hours. RESULTS Primary care pediatricians (n=56) in this study generated a total of 1,523,872 access-log data points (across 1,069 physician workdays) and spent an average of 3.9 and 1.2 hours per physician per workday engaged in the EHR during and outside work hours, respectively. About three-quarters of the time engaged in the EHR during or outside work hours was spent reviewing data and reports. Mixed effects regression revealed no associations of age, sex, nor clinical full-time equivalent status with EHR use during or outside work hours. CONCLUSIONS For every hour primary care pediatricians in this study spent engaged with the EHR during work hours, they spent about 20 minutes interacting with the EHR outside work hours. Most of their time (both during and outside of work hours) was spent reviewing data, records, and other information in the EHR.