Variation in Measures of Electronic Health Record Use Outside Scheduled Hours: A Cross-Sectional Study of Academic...

The amount of time ambulatory physicians spend in an electronic health record (EHR) outside scheduled hours has grown in recent years and been linked to burnout. Measures provided by EHR vendors can help health systems track EHR use outside scheduled hours, but different measures track different periods of EHR use and none currently tracks all EHR use outside patient scheduled hours. How much vendor-derived measures differ from one another or from total EHR use outside patient scheduled hours is unclear.

The objective of this study is to compare measures of EHR use outside scheduled hours.

We collected data on 195 academic primary care physicians' EHR use and clinic schedules between February and July 2025. We measured each physician's EHR use outside patient scheduled hours (i.e., Work Outside of Work) and compared this investigator-derived measure to three vendor-derived measures of EHR use outside scheduled hours.

Study physicians averaged 6.0 hours of total EHR use and 2.9 hours of EHR use outside patient scheduled hours (i.e., Work Outside of Work) for every eight patient scheduled hours. The vendor-derived measures of Pajama Time, Time on Unscheduled Days plus Time Outside Scheduled Hours, and Time Outside of Clinic Hours averaged 0.9, 2.2, and 2.6 hours per eight patient scheduled hours, respectively.

Almost half of study physicians' EHR use occurred outside patient scheduled hours. Common vendor-derived measures captured varying amounts of EHR use outside scheduled hours and all were less than total EHR use outside patient scheduled hours. This variation could affect calculations used to inform EHR training, program evaluation, or expectations for patient scheduled hours. Health systems should thus exercise caution when using vendor-derived measures to estimate total EHR use outside patient scheduled hours and continue to work with EHR vendors to develop scalable measures of EHR use that support diverse operational applications.