Specialty and operator status influence electronic health record use variation

Electronic health record (EHR) systems are central to modern practice yet contribute to physician workload and burnout. Metrics such as documentation timeliness, efficiency, and after-hours "pajama time" are increasingly used to assess provider performance, but variation across procedural roles and specialties remains understudied.

Cross-sectional study.

We analyzed 23 months of provider-level EHR data from a single academic health system. Providers with more than 0 operative notes were classified as operators. Six standardized metrics-delayed visit closure, delayed discharge note signing, delayed cosign and verbal order completion, delayed review of high-priority results, mean pajama time, and an institutional proficiency score-were compared between operators and nonoperators using Welch t tests. Subgroup analyses were performed within medicine, obstetrics-gynecology (ob-gyn), and pediatrics. Additional operator comparisons across 6 procedural specialties used analysis of variance.

Of 2516 providers, 724 (28.8%) were operators. Operators had higher rates of delayed cosign (9.5% vs 5.7%; P < .001) and verbal order completion (20.5% vs 17.1%; P = .003) but similar pajama time and proficiency compared with nonoperators. In medicine, operators had lower pajama time than nonoperators (21.8 vs 29.2 minutes; P = .006). In pediatrics, operators had fewer delayed discharge notes (P = .035). In ob-gyn, operators showed fewer verbal order and result review delays but higher proficiency and more delayed discharge notes (all P < .05). Among procedural specialties, ophthalmology operators had the highest proficiency yet greater delays across timeliness metrics (all P < .05).

EHR utilization varies by procedural status and specialty, underscoring the need for workflow-specific optimization rather than uniform performance benchmarks.