Abstract
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.
Keywords
electronic health records - medical education - resident physicians
