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Assessing the impact of the COVID-19 pandemic on clinician ambulatory electronic health record use

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 i...

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Autores principales: Holmgren, A Jay, Downing, N Lance, Tang, Mitchell, Sharp, Christopher, Longhurst, Christopher, Huckman, Robert S
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Oxford University Press 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8689796/
https://www.ncbi.nlm.nih.gov/pubmed/34888680
http://dx.doi.org/10.1093/jamia/ocab268
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author Holmgren, A Jay
Downing, N Lance
Tang, Mitchell
Sharp, Christopher
Longhurst, Christopher
Huckman, Robert S
author_facet Holmgren, A Jay
Downing, N Lance
Tang, Mitchell
Sharp, Christopher
Longhurst, Christopher
Huckman, Robert S
author_sort Holmgren, A Jay
collection PubMed
description 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.
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spelling pubmed-86897962022-01-05 Assessing the impact of the COVID-19 pandemic on clinician ambulatory electronic health record use Holmgren, A Jay Downing, N Lance Tang, Mitchell Sharp, Christopher Longhurst, Christopher Huckman, Robert S J Am Med Inform Assoc Research and Applications 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. Oxford University Press 2021-12-09 /pmc/articles/PMC8689796/ /pubmed/34888680 http://dx.doi.org/10.1093/jamia/ocab268 Text en © The Author(s) 2021. Published by Oxford University Press on behalf of the American Medical Informatics Association. All rights reserved. For permissions, please email: journals.permissions@oup.com https://academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_modelThis article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model (https://academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model)
spellingShingle Research and Applications
Holmgren, A Jay
Downing, N Lance
Tang, Mitchell
Sharp, Christopher
Longhurst, Christopher
Huckman, Robert S
Assessing the impact of the COVID-19 pandemic on clinician ambulatory electronic health record use
title Assessing the impact of the COVID-19 pandemic on clinician ambulatory electronic health record use
title_full Assessing the impact of the COVID-19 pandemic on clinician ambulatory electronic health record use
title_fullStr Assessing the impact of the COVID-19 pandemic on clinician ambulatory electronic health record use
title_full_unstemmed Assessing the impact of the COVID-19 pandemic on clinician ambulatory electronic health record use
title_short Assessing the impact of the COVID-19 pandemic on clinician ambulatory electronic health record use
title_sort assessing the impact of the covid-19 pandemic on clinician ambulatory electronic health record use
topic Research and Applications
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8689796/
https://www.ncbi.nlm.nih.gov/pubmed/34888680
http://dx.doi.org/10.1093/jamia/ocab268
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