Measuring time clinicians spend using EHRs in the inpatient setting: a national, mixed-methods study

Abstract

Abstract Objective To understand hospitals’ use of EHR audit-log-based measures to address burden associated with inpatient EHR use. Materials and Methods Using mixed methods, we analyzed 2018 American Hospital Association Information Technology Supplement Survey data (n = 2864 hospitals; 64% response rate) to characterize measures used and provided by EHR vendors to track clinician time spent documenting. We interviewed staff from the top 3 EHR vendors that provided these measures. Multivariable analyses identified variation in use of the measures among hospitals with these 3 vendors. Results 53% of hospitals reported using EHR data to track clinician time documenting, compared to 68% of the hospitals using the EHR from the top 3 vendors. Among hospitals with EHRs from these vendors, usage was significantly lower among rural hospitals and independent hospitals (P < .05). Two of these vendors provided measures of time spent doing specific tasks while the third measured an aggregate of auditable activities. Vendors varied in the underlying data used to create measures, measure specification, and data displays. Discussion Tools to track clinicians’ documentation time are becoming more available. The measures provided differ across vendors and disparities in use exist across hospitals. Increasing the specificity of standards underlying the data would support a common set of core measures making these measures more widely available. Conclusion Although half of US hospitals use measures of time spent in the EHR derived from EHR generated data, work remains to make such measures and analyses more broadly available to all hospitals and to increase its utility for national burden measurement.