Appl Clin Inform 2021; 12(04): 721-728
DOI: 10.1055/s-0041-1732403
Research Article

Resident Physician Experience and Duration of Electronic Health Record Use

A. Jay Holmgren
1   Center for Clinical Informatics and Improvement Research, School of Medicine, University of California, California, United States
Brenessa Lindeman
2   Department of Surgery, School of Medicine, The University of Alabama at Birmingham, Birmingham, Alabama, United States
Eric W. Ford
3   School of Public Health, The University of Alabama at Birmingham, Birmingham, Alabama, United States
› Author Affiliations


Background Electronic health records (EHRs) demand a significant amount of physician time for documentation, orders, and communication during care delivery. Resident physicians already work long hours as they gain experience and develop both clinical and socio-technical skills.

Objectives Measure how much time resident physicians spend in the EHR during clinic hours and after-hours, and how EHR usage changes as they gain experience over a 12-month period.

Methods Longitudinal descriptive study where participants were 622 resident physicians across postgraduate year cohorts (of 948 resident physicians at the institution, 65.6%) working in an ambulatory setting from July 2017 to June 2018. Time spent in the EHR per patient, patients records documented per day, and proportion of EHR time spent after-hours were the outcome, while the number of months of ambulatory care experience was the predictor.

Results Resident physicians spent an average of 45.6 minutes in the EHR per patient, with 13.5% of that time spent after-hours. Over 12 months of ambulatory experience, resident physicians reduced their EHR time per patient and saw more patients per day, but the proportion of EHR time after-hours did not change.

Conclusion Resident physicians spend a significant amount of time working in the EHR, both during and after clinic hours. While residents improve efficiency in reducing EHR time per patient, they do not reduce the proportion of EHR time spent after-hours. Concerns over the impact of EHRs on physician well-being should include recognition of the burden of EHR usage on early-career physicians.

Protection of Human and Animal Subjects

This study was designated not human subjects research and exempt by the Institutional Review Board at the University of Alabama at Birmingham.


The views expressed in this article are of the authors and do not necessarily represent the views of the institution providing the data. All data used in the study are proprietary and belongs to the University of Alabama at Birmingham Health System. This study was previously presented at American Medical Informatics Association Annual Symposium 2020.

Publication History

Received: 02 February 2021

Accepted: 21 June 2021

Article published online:
04 August 2021

© 2021. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

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