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  • March 2022
  • Article
  • Journal of the American Medical Informatics Association

Assessing the Impact of the COVID-19 Pandemic on Clinician Ambulatory Electronic Health Record Use

By: A Jay Holmgren, Lance Downing, Mitchell Tang, Christopher Sharp, Christopher Longhurst and Robert S. Huckman
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Abstract

Objective: The COVID-19 pandemic changed clinician electronic health record (EHR) work in a multitude of ways. To evaluate how, we measure ambulatory clinician EHR use in the United States throughout the COVID-19 pandemic.

Materials and Methods: We use EHR meta-data from ambulatory care clinicians in 366 health systems using the Epic EHR system in the United States from December 2019 to December 2020. We used descriptive statistics for clinician EHR use including active-use time across clinical activities, time after-hours, and messages received. Multivariable regression to evaluate total and after-hours EHR work adjusting for daily volume and organizational characteristics, and to evaluate the association between messages and EHR time.

Results: Clinician time spent in the EHR per day dropped at the onset of the pandemic but had recovered to higher than prepandemic levels by July 2020. Time spent actively working in the EHR after-hours showed similar trends. These differences persisted in multivariable models. In-Basket messages received increased compared with prepandemic levels, with the largest increase coming from messages from patients, which increased to 157% of the prepandemic average. Each additional patient message was associated with a 2.32-min increase in EHR time per day (P < .001).

Discussion: Clinicians spent more total and after-hours time in the EHR in the latter half of 2020 compared with the prepandemic period. This was partially driven by increased time in Clinical Review and In-Basket messaging.

Conclusions: Reimbursement models and workflows for the post-COVID era should account for these demands on clinician time that occur outside the traditional visit.

Keywords

Health Care; Electronic Health Records; Productivity; COVID-19 Pandemic; Health Care and Treatment; Health Pandemics; Information Technology; Performance Productivity; United States

Citation

Holmgren, A Jay, Lance Downing, Mitchell Tang, Christopher Sharp, Christopher Longhurst, and Robert S. Huckman. "Assessing the Impact of the COVID-19 Pandemic on Clinician Ambulatory Electronic Health Record Use." Journal of the American Medical Informatics Association 29, no. 3 (March 2022): 453–460.
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About The Author

Robert S. Huckman

Technology and Operations Management
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More from the Authors
  • Investigating the Association Between Telemedicine Use and Timely Follow-Up Care After Acute Cardiovascular Hospital Encounters By: Mitchell Tang, A Jay Holmgren, Erin E. McElrath, Ankeet S. Bhatt, Anubodh S. Varshney, Simin Gharib Lee, Muthiah Vaduganathan, Dale S. Adler and Robert S. Huckman
  • Rapid Growth of Remote Patient Monitoring Is Driven by a Small Number of Primary Care Providers By: Mitchell Tang, Ateev Mehrotra and Ariel Dora Stern
  • How Will Amazon Approach U.S. Primary Care? By: Robert S. Huckman and Bradley Staats
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