Appl Clin Inform 2024; 15(01): 034-044
DOI: 10.1055/a-2194-1061
Research Article

Electronic Health Record Usage Patterns Across Surgical Subspecialties

Kevin Tang*
1   Albert Einstein College of Medicine, Bronx, New York, United States
Kevin Labagnara*
1   Albert Einstein College of Medicine, Bronx, New York, United States
Mustufa Babar
1   Albert Einstein College of Medicine, Bronx, New York, United States
Justin Loloi
2   Department of Urology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, United States
Kara L. Watts
2   Department of Urology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, United States
Sunit Jariwala
3   Department of Medicine, Division of Allergy/Immunology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, United States
Nitya Abraham
2   Department of Urology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, United States
› Author Affiliations
Funding None.


Objectives This study aimed to utilize metrics from physician action logs to analyze surgeon clinical, volume, electronic health record (EHR) efficiency, EHR proficiency, and workload outside scheduled time as impacted by physician characteristics such as years of experience, gender, subspecialty, academic title, and administrative title.

Methods We selected 30 metrics from Epic Signal, an analytic tool in Epic that extracts metrics related to clinician documentation. Metrics measuring appointments, messages, and scheduled hours per day were used as a correlate for volume. EHR efficiency, and proficiency were measured by scores built into Epic Signal. Metrics measuring time spent in the EHR outside working hours were used as a correlate for documentation burden. We analyzed these metrics among surgeons at our institution across 4 months and correlated them with physician characteristics.

Results Analysis of 133 surgeons showed that, when stratified by gender, female surgeons had significantly higher EHR metrics for time per day, time per appointment, and documentation burden, and significantly lower EHR metrics for efficiency when compared to male surgeons. When stratified by experience, surgeons with 0 to 5 years of experience had significantly lower EHR metrics for volume, time per day, efficiency, and proficiency when compared to surgeons with 6 to 10 and more than 10 years of experience. On multivariate analysis, having over 10 years of experience was an independent predictor of more appointments per day, greater proficiency, and spending less time per completed message. Female gender was an independent predictor of spending more time in notes per appointment and time spent in the EHR outside working hours.

Conclusion The burden associated with volume, proficiency, efficiency, and workload outside scheduled time related to EHR use varies by gender and years of experience in our cohort of surgeons. Evaluation of physician action logs could help identify those at higher risk of burnout due to burdensome medical documentation.

Protection of Human and Animal Subjects

This study was performed in compliance with the World Medical Association Declaration of Helsinki on Ethical Principles for Medical Research Involving Human Subjects and was reviewed by the Albert Einstein College of Medicine Institutional Review Board.

All subjects were de-identified prior to conducting this study.

Authors' Contributions

All authors made substantial contributions to conception and design, acquisition of data and/or analysis/interpretation of data, and drafting and critical revision of the article for important intellectual content. All listed authors approved the version to be published.

* These authors contributed equally to this work.

Publication History

Received: 07 August 2023

Accepted: 17 October 2023

Accepted Manuscript online:
18 October 2023

Article published online:
10 January 2024

© 2024. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

  • References

  • 1 American Recovery and Reinvestment Act of 2009. 111th Congress (2009–2010). Accessed January 3, 2023 at:
  • 2 Hecht J. The future of electronic health records. Nature 2019; 573 (7775) S114-S116
  • 3 Shanafelt TD, Dyrbye LN, Sinsky C. et al. Relationship between clerical burden and characteristics of the electronic environment with physician burnout and professional satisfaction. Mayo Clin Proc 2016; 91 (07) 836-848
  • 4 Robertson SL, Robinson MD, Reid A. Electronic health record effects on work-life balance and burnout within the I3 population collaborative. J Grad Med Educ 2017; 9 (04) 479-484
  • 5 Downing NL, Bates DW, Longhurst CA. Physician burnout in the electronic health record era: are we ignoring the real cause?. Ann Intern Med 2018; 169 (01) 50-51
  • 6 Collier R. Electronic health records contributing to physician burnout. CMAJ 2017; 189 (45) E1405-E1406
  • 7 Seu M, Cho BH, Pigott R. et al. Trends and perceptions of electronic health record usage among plastic surgeons. Plast Reconstr Surg Glob Open 2020; 8 (04) e2709
  • 8 Moy AJ, Schwartz JM, Chen R. et al. Measurement of clinical documentation burden among physicians and nurses using electronic health records: a scoping review. J Am Med Inform Assoc 2021; 28 (05) 998-1008
  • 9 Moy AJ, Hobensack M, Marshall K. et al. Understanding the perceived role of electronic health records and workflow fragmentation on clinician documentation burden in emergency departments. J Am Med Inform Assoc 2023; 30 (05) 797-808
  • 10 Budd J. Burnout related to electronic health record use in primary care. J Prim Care Community Health 2023 ;14:21501319231166921
  • 11 Tan HJ, Chung AE, Gotz D. et al. Electronic health record use and perceptions among urologic surgeons. Appl Clin Inform 2023; 14 (02) 279-289
  • 12 Aziz F, Talhelm L, Keefer J, Krawiec C. Vascular surgery residents spend one fifth of their time on electronic health records after duty hours. J Vasc Surg 2019; 69 (05) 1574-1579
  • 13 Kesler K, Wynn M, Pugely AJ. Time and clerical burden posed by the current electronic health record for orthopaedic surgeons. J Am Acad Orthop Surg 2022; 30 (01) e34-e43
  • 14 Read-Brown S, Hribar MR, Reznick LG. et al. Time requirements for electronic health record use in an academic ophthalmology center. JAMA Ophthalmol 2017; 135 (11) 1250-1257
  • 15 Cox ML, Risoli Jr T, Peskoe SB, Turner DA, Migaly J. Quantified electronic health record (EHR) use by academic surgeons. Surgery 2021; 169 (06) 1386-1392
  • 16 Gupta K, Murray SG, Sarkar U. et al. Differences in ambulatory EHR use patterns for male vs. female physicians. NEJM Catal 2019 ;5(6)
  • 17 Beiser M, Lu V, Paul S. et al. Electronic health record usage patterns: assessing telemedicine's impact on the provider experience during the COVID-19 pandemic. Telemed J E Health 2021; 27 (08) 934-938
  • 18 Jeppson K. What can Epic's signal data tell us about EHR satisfaction and burnout. KLAS Impact Report; 2020 . Accessed December 26, 2022 at:
  • 19 Ruan E, Beiser M, Lu V. et al. Physician electronic health record usage as affected by the COVID-19 pandemic. Appl Clin Inform 2022; 13 (04) 785-793
  • 20 Dyrbye LN, Shanafelt TD, Balch CM, Satele D, Sloan J, Freischlag J. Relationship between work-home conflicts and burnout among American surgeons: a comparison by sex. Arch Surg 2011; 146 (02) 211-217
  • 21 Lu PW, Columbus AB, Fields AC, Melnitchouk N, Cho NL. Gender differences in surgeon burnout and barriers to career satisfaction: a qualitative exploration. J Surg Res 2020; 247: 28-33
  • 22 Dahlke AR, Johnson JK, Greenberg CC. et al. Gender differences in utilization of duty-hour regulations, aspects of burnout, and psychological well-being among general surgery residents in the United States. Ann Surg 2018; 268 (02) 204-211
  • 23 Mete M, Dickman J, Rowe S. et al. Beyond burnout: understanding the well-being gender gap in general surgery by examining professional fulfillment and control over schedule. Am J Surg 2022; 223 (04) 609-614
  • 24 Galaiya R, Kinross J, Arulampalam T. Factors associated with burnout syndrome in surgeons: a systematic review. Ann R Coll Surg Engl 2020; 102 (06) 401-407
  • 25 Hu YY, Ellis RJ, Hewitt DB. et al. Discrimination, abuse, harassment, and burnout in surgical residency training. N Engl J Med 2019; 381 (18) 1741-1752
  • 26 Benjamin T, Gulati A, Zebolsky AL. et al. Assessing the prevalence of burnout among female microvascular head and neck surgeons. Facial Plast Surg Aesthet Med 2023; 25 (04) 298-303