Variation in Measures of Electronic Health Record Use Outside Scheduled Hours: A Cross-Sectional Study of Academic Primary Care Physicians

Abstract

Background

The amount of time ambulatory physicians spend in an electronic health record (EHR) outside scheduled hours has grown in recent years and been linked to burnout. Measures provided by EHR vendors can help health systems track EHR use outside scheduled hours, but different measures track different periods of EHR use and none currently tracks all EHR use outside patient scheduled hours. How much vendor-derived measures differ from one another or from total EHR use outside patient scheduled hours is unclear.

Objective

The objective of this study is to compare measures of EHR use outside scheduled hours.

Methods

We collected data on 195 academic primary care physicians' EHR use and clinic schedules between February and July 2025. We measured each physician's EHR use outside patient scheduled hours (i.e., Work Outside of Work ) and compared this investigator-derived measure to three vendor-derived measures of EHR use outside scheduled hours.

Results

Study physicians averaged 6.0 hours of total EHR use and 2.9 hours of EHR use outside patient scheduled hours (i.e., Work Outside of Work ) for every eight patient scheduled hours. The vendor-derived measures of Pajama Time, Time on Unscheduled Days plus Time Outside Scheduled Hours , and Time Outside of Clinic Hours averaged 0.9, 2.2, and 2.6 hours per eight patient scheduled hours, respectively.

Conclusion

Almost half of study physicians' EHR use occurred outside patient scheduled hours. Common vendor-derived measures captured varying amounts of EHR use outside scheduled hours and all were less than total EHR use outside patient scheduled hours. This variation could affect calculations used to inform EHR training, program evaluation, or expectations for patient scheduled hours. Health systems should thus exercise caution when using vendor-derived measures to estimate total EHR use outside patient scheduled hours and continue to work with EHR vendors to develop scalable measures of EHR use that support diverse operational applications.

Background and Significance

The amount of time ambulatory physicians spend in an electronic health record (EHR) outside scheduled hours has grown in recent years as staffing shortages, increasing inbox work, and other factors have disrupted health care. 1 2 3 Ambulatory physicians at one academic health center, for example, spent 24% more time in their EHR outside scheduled hours between August 2020 and September 2021 than they did 2 years prior. 2 Physicians may use an EHR outside scheduled hours to perform vital tasks such as documenting patient care, managing test results, authorizing prescriptions, responding to patient messages, and preparing for future appointments. However, EHR use outside scheduled hours has been linked to burnout, 4 5 6 7 prompting health systems to consider how they can redesign staffing, scheduling, workflows, training, and technology to reduce outside-hours EHR use and promote physician well-being. 8 9 10 11 12

Many health systems use vendor-derived measures to monitor EHR use and inform clinic operations. 13 Measures of EHR use outside scheduled hours, for example, can help health systems understand the volume of work performed outside scheduled appointments, identify physicians who might benefit from additional EHR training or support, monitor programs designed to reduce documentation burden, and balance time set aside for synchronous appointments with time scheduled for asynchronous care. 14 15 16 This balance may be operationalized not only in clinic schedules but also in physician job descriptions, for example, with explicit expectations for patient scheduled hours or number of half-day clinic sessions per week. 17 18 19

Vendor-derived measures, such as those provided by Epic and Oracle Cerner, make it possible to measure EHR use outside scheduled hours, although different measures track different periods of EHR use ( Fig. 1 ). 20 21 22 Some measures, such as Oracle Cerner's After Hours and Epic's Pajama Time , track EHR use outside heuristically defined working hours (e.g., 7:00 a.m. to 5:30 p.m. on weekdays), regardless of clinic schedules. 22 23 Other vendor-derived measures are more directly tied to physician schedules. Epic's Time Outside Scheduled Hours , for example, tracks EHR use outside “scheduled hours” on days with appointments, a period defined as extending from 30 minutes before the first completed appointment to 30 minutes after the last completed appointment of the day ( Fig. 1 ). 22 Many health systems and researchers have combined this measure with Epic's Time on Unscheduled Days to track EHR use outside scheduled hours across days with and without appointments. 24 25 26 Along these lines, Epic recently released a new measure, Time Outside of Clinic Hours , which tracks EHR use across days with and without appointments outside the period stretching from the start of the first to the end of the last completed appointment of each day ( Fig. 1 ). We collectively refer to these measures as measures of EHR use outside scheduled hours.

Fig. 1.

Periods of EHR use tracked in different measures of EHR use outside scheduled hours. EHR, electronic health record.

Having different measures of EHR use outside scheduled hours can be helpful. Evidence suggests that not all EHR use outside scheduled hours has the same relationship to burnout. 4 5 6 7 Disaggregating measures—such as by having different measures for EHR use on days with and without appointments—can help health systems and researchers monitor the periods of EHR use most associated with burnout. However, having different measures hinders synthesis of evidence across vendors, institutions, and studies. 24 It may also lead to variation in calculations used to inform clinic operations. Health systems, for example, may identify physicians with the most EHR use outside scheduled hours when deciding who to offer additional training or support, a group that could vary based on the measure used. Several recent studies have also combined measures of EHR use outside scheduled hours with the number of patient scheduled hours a physician has per week to estimate their total work hours. 14 15 These studies employed measures that did not include EHR use during periods such as mid-day gaps between appointments (e.g., lunch) or the half-hour at the start and end of the clinic day, 27 so they may have underestimated EHR use outside scheduled hours and total work hours.

To the best of our knowledge, no current vendor-derived measure tracks all EHR use outside patient scheduled hours, a measure that has previously been defined as Work Outside of Work . 28 While many studies report Work Outside of Work , most of these employ vendor-derived measures to approximate Work Outside of Work , 24 25 26 rather than calculate the measure directly from physician schedules and EHR metadata. 2 It is thus unclear how much Work Outside of Work differs from current vendor-derived measures of EHR use outside scheduled hours or the impact this variation might have on downstream uses of the measures.

Objective

The objective of this study was to compare one investigator-derived and three vendor-derived measures of primary care physicians' EHR use outside scheduled hours.

Methods

In this retrospective cross-sectional study, we compared one investigator-derived and three vendor-derived measures of EHR use outside scheduled hours across 6 months for 195 academic primary care physicians. This study was conducted at UW Health, the academic health center of the University of Wisconsin–Madison and was approved by the university's Minimal Risk Research Institutional Review Board. Physicians, advanced practice clinicians, and staff at UW Health care for more than 300,000 primary care patients at 33 family medicine, general internal medicine, and general pediatric clinics. Being an academic health center, many of these clinics are teaching clinics where residents care for a panel of primary care patients under the supervision of an attending physician. UW Health has been using an EHR developed by Epic (Verona, Wisconsin, United States) for ambulatory documentation and practice management since 2004.

To compare different measures of EHR use outside scheduled hours, we collected data on physician schedules, demographics, and EHR use between February and July 2025 from our institution's EHR. We collected data for physicians who had a primary care panel (i.e., patients for whom they were the primary care provider) and scheduled appointments every month throughout the study period. We excluded residents from the study. The data on EHR use included four vendor-derived measures from Epic's Signal reporting tool, two of which we combined into a single compound measure. These measures included Pajama Time, Time Outside Scheduled Hours , Time on Unscheduled Days , and Time Outside of Clinic Hours ( Fig. 1 ). We report the compound measure of Time Outside Scheduled Hours plus Time on Unscheduled Days , as many studies have used this combined measure to estimate total EHR use outside scheduled hours, in some cases equating this measure with Work Outside of Work . 24 25 26

To calculate the investigator-derived measure of Work Outside of Work , we collected active use logs (UAL Lite) that track how long each physician actively used the EHR during each 15-minute period (e.g., 8:00 a.m. to 8:15 a.m. on February 1, 2025). These logs are the basis of many time-based measures reported in Signal and track active EHR use based on a users' clicks, keystrokes, and scrolls. Periods in which less than 5 seconds pass between these low-level events are generally considered active EHR use. We combined the active use logs with each physician's schedule of appointments to calculate how long they spent in the EHR outside patient scheduled hours (i.e., Work Outside of Work ). We used physicians' full schedule of available appointments for which they were the visit provider or a preceptor (e.g., overseeing a visit led by a resident or fellow) to define their patient scheduled hours, including no-show and cancelled appointment slots. This characterization of physician schedules differs from some of the vendor-derived measures evaluated in this study, which are based on completed appointments and may thus not consider unfilled appointment slots or time spent precepting resident-led visits when defining scheduled hours (Epic's Provider Wellbeing Technical Services team, email, January 29, 2024). We excluded nonambulatory EHR use (e.g., inpatient care) and mobile EHR use from the calculation of Work Outside of Work .

Because the active use log reports EHR use in 15-minute increments, we had to estimate how much EHR use occurred outside scheduled hours when an appointment began or ended in the middle of one of these increments (e.g., 8:10 a.m.). To be conservative in our estimate of Work Outside of Work , we allocated as much EHR use as possible as having occurred inside patient scheduled hours. For example, if a physician had their first appointment of the day at 8:10 a.m. and used the EHR for 7 minutes between 8:00 and 8:15 a.m., we allocated 5 minutes as having occurred inside patient scheduled hours (e.g., from 8:10 to 8:15 a.m.), and 2 minutes as having occurred outside patient scheduled hours (e.g., between 8:00 and 8:10 a.m.). We used a similar method to estimate how much EHR use occurred during mid-day gaps between appointments (e.g., meetings, lunch).

We calculated a single value for each measure of EHR use outside scheduled hours for each physician across the study period by summing monthly measures of EHR use before normalizing the measure. We did this rather than average normalized monthly measures of EHR use to avoid the measures being overly influenced by a single month with an atypical schedule. To support diverse methods of comparison, we normalized each measure in three ways: minutes (or hours) per eight patient scheduled hours, percent of total EHR time, and minutes (or hours) per relevant day logged into the EHR (e.g., all days logged in, days with completed appointments). The durations and proportions of EHR use observed in this study were positively skewed, so we present medians and interquartile ranges (IQRs) for each measure as well as means. We used Wilcoxon signed-rank tests to compare measure magnitudes.

To assess the potential operational impact of the differences between measures, we performed two calculations relevant to clinic operations. First, we ranked physicians in each specialty according to each measure of EHR use outside scheduled hours when normalized per eight patient scheduled hours. We then identified how many physicians in the highest quartile of Work Outside of Work were also in the highest quartile of each of the three vendor-derived measures. We performed this rank comparison as health systems may use rankings of physician EHR time to target EHR training or support. Second, we replicated a previously-reported method of identifying how many patient scheduled hours a physician would need to—in combination with their EHR use outside patient scheduled hours—work a 40 hour week. 14 This method only counts patient scheduled hours and EHR use outside scheduled hours towards total work hours so likely underestimates work hours.

Results

This cross-sectional study included 195 primary care physicians, of whom 123 were female (63.1%) and 72 were male (36.9%) according to human resources data. One hundred physicians practiced family medicine (51.3%), 61 practiced general internal medicine (31.3%), and 34 practiced general pediatrics (17.4%). Study physicians had a median clinical full-time equivalency of 0.71 (mean, 0.71; IQR, 0.58–0.87).

Study physicians spent an average of 358 minutes (6.0 hours) actively using the EHR every eight patient scheduled hours, of which 175 minutes (2.9 hours) occurred outside patient scheduled hours ( Work Outside of Work, Table 1 ). When averaged across physicians as a percent of their total EHR time, Work Outside of Work accounted for 45.0% of study physicians' total EHR time. Each vendor-derived measure of EHR use outside scheduled hours was significantly lower than Work Outside of Work ( p  < 0.001, Wilcoxon signed-rank tests). Pajama Time, Time Outside Scheduled Hours plus Time on Unscheduled Days , and Time Outside of Clinic Hours averaged 56 minutes (0.9 hours), 133 minutes (2.2 hours), and 157 minutes (2.6 hours) per eight patient scheduled hours for the same physicians over the same period, and accounted for an average of 13.5, 34.4, and 41.4% of physicians' total EHR time, respectively. Each measure varied substantially by physician. For example, the IQR for Work Outside of Work was 1.5 to 3.9 hours per eight patient scheduled hours ( Fig. 2 ). Of the 49 physicians in the highest quartile of Work Outside of Work in their specialty, 39 were also in the highest quartile of Pajama Time , 44 were in the highest quartile of Time Outside Scheduled Hours plus Time on Unscheduled Days , and 45 were in the highest quartile of Time Outside of Clinic Hours when these measures were normalized per eight patient scheduled hours.

Table 1. Proportions and durations of outside-hours electronic health record use.

Measure	% of total EHR time			Minutes per 8 PSH			Minutes per login day
	Mean	Median	IQR	Mean	Median	IQR	Mean	Median	IQR
EHR time	–	–	–	358	334	259–420	152	148	115–180
WOW	45.0	44.9	34.9–56.5	175	146	93–234	70	60	43–88
TOCH	41.4	41.7	29.2–53.8	157	137	83–206	62	53	37–79
TOSH + TOUD	34.4	35.7	21.8–47.4	133	113	59–182	52	44	27–68
TOSH	18.7	18.0	10.7–25.7	70	56	31–96	51 a	43 a	24–67 a
TOUD	15.8	14.2	6.8–23.3	63	46	19–85	54 b	46 b	29–70 b
Pajama time	13.5	11.4	5.1–19.8	56	35	15–78	22	14	6–30
Between Apts	7.9	7.3	4.9–9.7	29	24	16–36	13 a	11 a	6–17 a

Abbreviations: Between Apts, EHR time between available appointments; EHR, electronic health record; PSH, patient scheduled hours; TOCH, time outside of clinic hours; TOSH, time outside scheduled hours; TOUD, time on unscheduled days; WOW, work outside of work.

^aPer day with completed appointments logged into the EHR.

^bPer day without completed appointments logged into the EHR.

Fig. 2.

Variation in measures of EHR use outside scheduled hours by measure and physician. Plot shows median, interquartile range, and range of each measure with outliers removed. EHR, electronic health record.

Study physicians had an average of 89 minutes (1.5 hours) of mid-day gaps between appointments per eight patient scheduled hours for activities such as inbox work, meetings, or lunch. They spent an average of 29 minutes (0.5 hours) in the EHR during this period, accounting for an average of 7.9% of study physician's total EHR use. Over half (17 minutes, 0.3 hours) of physicians' EHR use during mid-day gaps between appointments occurred over the lunch hour between 12:00 and 1:00 p.m.

Using a previously reported method of estimating the number of patient scheduled hours a physician would need to work a 40-hour work week led to an estimate of 29.3 patient scheduled hours per week when using Work Outside of Work to measure EHR use outside scheduled hours, 35.8 hours per week when using Pajama Time, 31.3 hours per week when using the compound measure of Time Outside Scheduled Hours plus Time on Unscheduled Days , and 30.1 hours per week when using Time Outside of Clinic Hours . 14

Discussion

In this cross-sectional study, we compared one investigator-derived measure and three vendor-derived measures of EHR use outside scheduled hours across 6 months and 195 academic primary care physicians. We found that study physicians spent an average of 2.9 hours actively using an EHR outside patient scheduled hours for every eight patient scheduled hours according to the investigator-derived measure of Work Outside of Work . Each of the three vendor-derived measures of EHR use outside scheduled hours was significantly lower for the same physicians over the same period. We also found that estimates of total work hours and rankings of physician EHR use varied by measure.

One key finding of this study was that nearly half (45.0%) of study physicians' EHR use occurred outside patient scheduled hours, averaging 2.9 hours per eight patient scheduled hours. This estimate aligns with prior work based on EHR audit logs, which found that 49% of ambulatory physician's EHR use occurred outside patient scheduled hours at one academic health center between late 2020 and early 2021. 2 For 79 of the 195 physicians included in this study, more than half of their EHR use occurred outside patient scheduled hours. EHR use varies substantially by physician, 29 and primary care physicians spend more time in the EHR than physicians in other specialties, 30 31 so the magnitudes of EHR use observed in this study may be higher than those that would be observed in other specialties. However, both the relative and absolute amount of EHR use outside scheduled hours in this study were substantial, suggesting health systems should not overlook asynchronous EHR use when setting expectations for physician work schedules. 16 And while artificial intelligence tools such as ambient scribes may help reduce the time physicians spend documenting, early evaluations suggest the use of these tools is not necessarily associated with less EHR use outside scheduled hours. 32 33 34 35 36 37 38

A second key finding of this research was that different measures of EHR use outside scheduled hours vary substantially in magnitude, reflecting underlying differences in the periods of EHR use they track ( Fig. 1 ). Compared with Work Outside of Work, Pajama Time was on average 68% lower for study physicians, Time Outside Scheduled Hours plus Time on Unscheduled Days was 24% lower, and Time Outside of Clinic Hours was 11% lower. These results suggest that measures based on clinic schedules (e.g., Time Outside Scheduled Hours plus Time on Unscheduled Days, Time Outside of Clinic Hours, Work Outside of Work ) provide a more complete account of EHR use outside scheduled hours than those based on heuristically defined working hours (e.g., Pajama Time ). This finding is echoed by prior work that found that Oracle Cerner's After Hours measure—which tracks EHR use outside the heuristically defined period of 6 a.m. to 6 p.m. on weekdays—accounted for just 11% to 12% of total EHR use, 23 39 which is similar to the 13.5% of total EHR use captured by the heuristically defined Pajama Time in this study. Yet even measures based on physician schedules varied based on whether they included EHR use during periods such as mid-day gaps between appointments. As more health systems consider including dedicated time for asynchronous care in physician schedules, 16 40 having a measure that tracks all EHR use outside patient scheduled hours, including EHR use during mid-day gaps between appointments, could help operational leaders better monitor time spent on asynchronous care.

How much this variation in measures matters depends on how the measures are used. Here we highlight the three potential uses of measures of EHR use outside scheduled hours: informing expectations for patient scheduled hours, identifying physicians to provide limited resources for training or support, and associating EHR use with well-being.

First, one emerging application for measures of EHR use outside scheduled hours is to help inform expectations for patient scheduled hours. One recent study used the combined measure of Time Outside Scheduled Hours and Time on Unscheduled Days to identify how much time physicians spent in the EHR outside scheduled hours for every hour of scheduled appointments. 14 The study then used this quantity to estimate how many patient scheduled hours a physician would need per week to achieve a 40-hour work week, assuming all work occurred either during a scheduled appointment or in the EHR outside scheduled hours. The median value in primary care was 33.2 patient scheduled hours per week. Another recent study used the same combination of vendor-derived measures and patient scheduled hours to estimate how many hours primary care physicians work each week, using evidence from a prior time-motion study to account for clinical work that occurred outside scheduled hours and outside the EHR. 15 These studies demonstrate a desire to use data on EHR use to inform decisions about physician schedules, even as the studies acknowledged the limitations of doing so (e.g., not all clinical work involves EHR use). 41 The current study suggests the results of such calculations are sensitive not only to previously described contextual factors—such as specialty, full-time equivalency, appointment fill rates, and target work hours per week—but also to the measure of EHR use employed. 13 An administrator employing the combined measure of Time Outside of Scheduled Hours plus Time on Unscheduled Days to perform the calculation above might set expectations for patient scheduled hours at 31 hours per week, whereas the same administrator using Work Outside of Work to perform the calculation they might set the expectation 2 hours lower at 29 hours per week. A similar difference would remain even if the administrator had different expectations for physicians' total work hours per week or set a target in terms of how much dedicated time providers should have for asynchronous care in every half-day of clinic.

A second application of measures of EHR use outside scheduled hours is to rank physicians by EHR use when deciding how to allocate limited resources for EHR training or support. The results of this study suggest that rankings of EHR use differ by measure, though with more stability in rankings than in overall measure magnitude. Whereas Time Outside Scheduled Hours plus Time on Unscheduled Days was 24% lower than Work Outside of Work , just 10% of physicians in the top quartile of Work Outside of Work were absent from the top quartile of Time Outside Scheduled Hours plus Time on Unscheduled Days . Measures based on heuristically defined working hours, such as Pajama Time , however, showed less agreement with those based on physician schedules.

A third application of measures of EHR use outside scheduled hours is to identify physicians at risk of burnout. Prior work has found that certain measures of EHR use outside scheduled hours are associated with burnout, but the evidence is mixed as to which measure has the strongest association. 4 5 6 7 As measures such as Time Outside of Clinic Hours or Work Outside of Work become more widely available, studies can examine whether these measures are more closely associated with burnout, or if other factors such as time to chart closure have a stronger relationship. 42

Vendor-derived measures of EHR use have enabled multicenter studies, comparison across clinical settings, and teams with limited analytical resources to observe EHR use at scale. 1 24 The ease with which vendor-derived measures can be collected compared with computing a custom measure has likely contributed to the fact that most analyses of EHR use now rely on vendor-derived measures, making them de facto standards for operations and research. 43 Measures that capture different periods of EHR use outside scheduled hours, such as EHR use on days with and without appointments, have enabled examination of the different associations between EHR use in these periods and physician burnout. 4 5 6 However, common vendor-derived measures do not capture all EHR use outside patient scheduled hours, which may have downstream effects on how these measures inform clinic operations.

Epic's new measure, Time Outside of Clinic Hours , is a vital step toward more completely tracking EHR use outside scheduled hours. EHR vendors might also consider implementing a measure such as Work Outside of Work (which also includes time spent during mid-day breaks between appointments) and normalizing the measure by patient scheduled hours (rather than days logged into the EHR) to support calculations of how much time physicians spend in the EHR outside patient appointments for every hour of scheduled appointments. Such a measure could help health systems balance time available for synchronous appointments with time available for asynchronous care. Creating such a measure, however, may require additional work by vendors and health systems to more consistently track unfilled appointment slots and time spent precepting resident-led visits if these periods are to be included in the definition of patient scheduled hours.

This research has several limitations that future work could address. First, Work Outside of Work had to be estimated because the data employed in this study tracked EHR use in 15-minute increments, which did not always align with the start or end of scheduled appointments (e.g., 8:10 a.m.). To address this limitation, we employed a conservative method to calculate Work Outside of Work that allocated as little EHR time as possible as having occurred outside patient scheduled hours. Second, despite relying on the same underlying data (UAL Lite), the investigator-derived and vendor-derived measures reported in this study may vary due to unknown differences in how data were processed. For example, we filtered the UAL Lite data to exclude nonambulatory EHR use and EHR use on mobile platforms when calculating Work Outside of Work but included time spent in reporting tools or personalizing the EHR. The total time we observed physicians spending in the EHR based on this method was on average 6 minutes (1.8%) higher per eight patient scheduled hours than the amount reported in the vendor-derived measure of Time in System (i.e., 358 vs. 352 minutes). Third, the reported measures did not disaggregate EHR use outside scheduled hours by activity (e.g., inbox, notes, orders). Future work might explore which types of EHR activity are more likely to be performed outside patient scheduled hours. Fourth, this study examined EHR use by primary care physicians at one academic medical center, so the results may not generalize to other EHR users or settings. Fifth, this study did not identify which measures of EHR use outside scheduled hours were most associated with burnout. Sixth, the data used to measure active EHR use in this study stopped tracking time when low-level interactions such as clicks, keystrokes or scrolls were more than 5-second apart, which may lead to undercounting EHR time when physicians engage in activities such as reading notes. Finally, not all clinical activity can be tracked through EHR metadata since not all clinical work involves interacting with an EHR. Any measure based on traces of EHR use, thus likely underestimates time spent on clinical work compared with a gold standard method such as direct observation.

Conclusion

Measures of EHR use outside scheduled hours can help health systems monitor and make decisions about the total time needed to provide care. This study finds common vendor-derived measures do not capture all EHR use outside patient scheduled hours and that measure choice may affect subsequent calculations used to inform decisions such as the allocation of limited resources for EHR training or support or setting expected patient scheduled hours. Researchers, health systems, and policymakers should consider not only the differences in measure magnitude, but also the differences in periods of EHR use tracked by each measure, and the intended use of each measure when selecting measures to guide operations, policymaking, and research. Future work might continue to explore how measures of EHR use outside scheduled hours can best support operations and research, how interventions designed to reduce EHR use can be tailored to individual physicians to have the most impact, and how different periods of EHR use outside scheduled hours associate with physician wellbeing.

Funding Statement

Funding Information American Medical Association, EHR-Use Metrics Research, grant no.: 19455. Funding for open access publishing was made available by the generosity of the Sarah M. Pritchard Faculty Support Fund.

Clinical Relevance Statement

This manuscript presents the results of a retrospective cross-sectional analysis comparing four measures of EHR use outside scheduled hours for the same set of 195 academic primary care physicians. We find that nearly half of primary care physicians' EHR use occurs outside time scheduled for patient appointments and that common vendor-derived measures of EHR use outside scheduled hours do not capture all of this time. These results suggest health systems might benefit from measures that capture all EHR use outside scheduled hours to better understand the volume of this work and to consider how clinic schedules and primary care job descriptions can be redesigned to provide sufficient time for asynchronous care.

Multiple-Choice Questions

1. How much of ambulatory primary care physicians' electronic health record use occurs outside patient scheduled hours?

   1. About 10%

   2. About 30%

   3. About 50%

   4. About 70%

   Correct Answer : The correct answer is option c. This study found 45.0% of academic primary care physician's EHR use occurred outside time set aside for patient appointments (i.e., patient scheduled hours) or 175 minutes per eight patient scheduled hours. Prior work that employed audit logs to measure ambulatory physicians' EHR use at another academic medical center similarly found nearly half of their EHR use occurred outside patient scheduled hours.

2. How much time did ambulatory physicians spend using the EHR in gaps between available appointments per eight patient scheduled hours?

   1. About 10 minutes

   2. About 20 minutes

   3. About 30 minutes

   4. About 60 minutes

   Correct Answer : The correct answer is option c. This study found that academic primary care physicians spent 29 minutes using the EHR in gaps between available appointments (e.g., time set aside for lunch, meetings, or panel management) per eight patient scheduled hours. Study physicians had an average of 89 minutes of gap in their schedule per eight patient scheduled hours, meaning about 1/3 of this time was spent actively engaged with the EHR.