CC BY-NC-ND 4.0 · Journal of Academic Ophthalmology 2020; 12(02): e143-e150
DOI: 10.1055/s-0040-1716411
Research Article

Electronic Health Record Use among Ophthalmology Residents while on Call

Christopher P. Long
1   Viterbi Family Department of Ophthalmology, Shiley Eye Institute, University of California San Diego, La Jolla, California
Ming Tai-Seale
2   Department of Family Medicine and Public Health, University of California San Diego, La Jolla, California
Robert El-Kareh
3   Health Department of Biomedical Informatics, University of California San Diego, La Jolla, California
Jeffrey E. Lee
1   Viterbi Family Department of Ophthalmology, Shiley Eye Institute, University of California San Diego, La Jolla, California
Sally L. Baxter
1   Viterbi Family Department of Ophthalmology, Shiley Eye Institute, University of California San Diego, La Jolla, California
3   Health Department of Biomedical Informatics, University of California San Diego, La Jolla, California
› Author Affiliations
Funding The study was supported by the National Institutes of Health (Bethesda, MD) (Grant T15LM011271) and the Heed Ophthalmic Foundation.


Background As electronic health record (EHR) use becomes more widespread, detailed records of how users interact with the EHR, known as EHR audit logs, are being used to characterize the clinical workflows of physicians including residents. After-hours EHR use is of particular interest given its known association with physician burnout. Several studies have analyzed EHR audit logs for residents in other fields, such as internal medicine, but none thus far in ophthalmology. Here, we focused specifically on EHR use during on-call shifts outside of normal clinic hours.

Methods In this retrospective study, we analyzed raw EHR audit log data from on-call shifts for 12 ophthalmology residents at a single institution over the course of a calendar year. Data were analyzed to characterize total time spent using the EHR, clinical volume, diagnoses of patients seen on call, and EHR tasks.

Results Across all call shifts, the median and interquartile range (IQR) of the time spent logged into the EHR per shift were 88 and 131 minutes, respectively. The median (IQR) unique patient charts accessed per shift was 7 (9) patients. When standardized to per-hour measures, weekday evening shifts were the busiest call shifts with regard to both EHR use time and clinical volume. Total EHR use time and clinical volume were greatest in the summer months (July to September). Chart review comprised a majority (63.4%) of ophthalmology residents' on-call EHR activities.

Conclusion In summary, EHR audit logs demonstrate substantial call burden for ophthalmology residents outside of regular clinic hours. These data and future studies can be used to further characterize the clinical exposure and call burden of ophthalmology residents and could potentially have broader implications in the fields of physician burnout and education policy.


The authors report no commercial or proprietary interest in any product or concept discussed in this article.

Publication History

Received: 30 May 2020

Accepted: 30 July 2020

Article published online:
10 September 2020

© 2020. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (

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