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EHR Study Finds Value in Time Spent on the Computer

Analysis  |  By Eric Wicklund  
   October 19, 2022

Research by Brigham and Women's finds that more time spent on the EHR can improve primary care quality outcomes, but there's a fine line between the right amount and too much.

New research out of Brigham and Women's finds that more time spent on the electronic health record platform can improve quality outcomes in primary care, though providers still need to make sure they're not overdoing it.

As reported in the Journal of the American Medical Association (JAMA), researchers at the Boston-based health system tracked ambulatory quality measures for 291 primary care physicians affiliated with either B&W or Massachusetts General Hospital in 2021. They reported "significant associations between EHR time and panel-level achievement of hemoglobin A1c control, hypertension control, and breast cancer screening targets."

The research team, led by Lisa Rotenstein, MD, MBA, and Michael Healey, MD, both of Brigham and Women's and Harvard Medical School, and A. Jay Holmgren, PhD, of the University of California at San Francisco (UCSF), noted that they tracked EHR time not only during the day, but also after hours and during what is called "pajama time" (evenings and weekends). They also separated and tracked time spent on clinical matters and "in-basket" tasks.

"It is notable that among all metrics of EHR time examined, there was the greatest numerical association between daily time on the in-basket and daily time on clinical review and ambulatory quality outcomes," the study noted. "Although time spent on clinical review on the day of a visit can now be accounted and billed for under the 2021 Evaluation and Management coding changes, time spent on the in-basket is typically not compensated. Rather, in-basket work is performed in addition to visit-based, revenue-generating work, often outside of scheduled clinic hours. In addition to substantially increasing since the COVID-19 pandemic, time spent addressing in-basket content has been associated with an increased likelihood of burnout and intent to reduce clinical hours."

[See also: HIMSS22 Takes on Healthcare's Biggest Challenges.]

That said, Rotenstein and her team pointed out that more time spent on the EHR "may represent a level of thoroughness, attention to detail, or patient and team communication that ultimately enhances certain outcomes."

The challenge, then, is to find a balance between spending meaningful time on the EHR and ensuring it isn't negatively affecting care quality or the caregiver's health.

"These results underscore the need to create team structures, examine PCP and office workflows, and enhance EHR-based technologies and decision support tools in ways that enable high quality of care, while optimizing time spent on the EHR," they concluded.

In addition, Rotenstein and her colleagues wrote, "Future studies should seek to identify the specific work patterns that contribute to the associations we have identified and characterize payment strategies, workflows, and technologies that can facilitate PCPs delivering high-quality ambulatory care while minimizing EHR burden."

Eric Wicklund is the associate content manager and senior editor for Innovation, Technology, and Pharma for HealthLeaders.


Studies have found that too much time spent on the EHR can lead to stress and burnout, alongside negative clinical outcomes.

New research, meanwhile, finds that more time spent on the EHR, including after hours, can boost quality incomes in primary care.

The challenge lies in determining how much time is enough, and creating protocols and workflows that enhance that time and reduce stress.

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