After-Hours Use of the Electronic Health Record Among Medical and Surgical Specialists After Implementation of a...

Studies suggest that the introduction of electronic health records (EHRs) has decreased the efficiency of clinical practice and increased clinician workload for US-based physicians. Most studies involve clinicians in primary care settings. Less is known about other health care settings, subspecialist clinicians, or whether markers of efficiency and workload change over time.

This study aimed to describe 2 common metrics of after-hours use of the EHR (pajama time and time outside scheduled hours [TOSH]) among diverse specialists and track these parameters longitudinally in a Canadian setting.

In this longitudinal descriptive study, medical and surgical specialists were observed starting from the introduction of a system-wide EHR in 2019 to 2022 at a large quaternary teaching hospital in Edmonton, Alberta. Pajama time and TOSH were extracted from the EHR on an Epic system platform and monitored over time. Clinicians were stratified according to clinical group (medical and surgical) and workload (clinical full-time equivalent).

A total of 71 medical and surgical specialists participated in this study, spending approximately 24 to 40 minutes per day on pajama time and 32 to 55 minutes per day on TOSH depending on clinician grouping. Both metrics increased over the observation period, as reflected in the longitudinal plots and the higher values observed at the end vs the beginning of follow-up.

After-hours EHR use in this Canadian cohort of medical and surgical specialists was similar to what is reported in the US literature, although the drivers may be different. Perhaps surprisingly, these markers increased over time despite presumed improved familiarity with the EHR. The extent to which this affects clinician well-being and work-life integration cannot be determined from these results, although there may be cause for concern.