Table 1.

Proposed core EHR use measures

Measure	Abbreviation	Definition and example
Total EHR time	EHR-Time8	Total time on EHR (during and outside of clinic sessions) per 8 h of patient scheduled time.
		Example: A physician with 32 patient-scheduled hours per week, 20 h of EHR time during scheduled hours, 10 h of WOW each week would have EHR-Time8 of 30/32 × 8 = 7.5.
Work outside of work	WOW8	Time on EHR outside of scheduled patient hours per 8 h of patient scheduled time.a
		Example: A physician with 32 scheduled patient hours per week and a total of 10 h of EHR time outside of these scheduled hours, would have WOW8 = 10/32 × 8 = 2.5.
Time on encounter note documentation	Note-Time8	Hours on documentation (note writing) per 8 h of scheduled patient time
		Example: A physician with 32 scheduled patient hours per week and a total of 20 h of documentation time (both in the room with the patient and outside of the room) per week would have DocTime8 of 20/32 × 8 = 5.0.
Time on prescriptions	Script-Time8	Total time on prescriptions per 8 h of patient scheduled time
		Example: A physician spends 3 h per week on prescription work and has 24 h of patient scheduled time per week. Script8 = 3/24 × 8 = 1
Time on inbox	IB-Time8	Total time on inbox per 8 h of patient scheduled time
		Example: A physician spends 10 h per week on Inbox work and has 20 h per week of patient scheduled time. IB8 = 10/20 × 8 = 4
Teamwork for orders	TWORD	The percentage of orders with team contribution
		Example: A physician working with a team that is empowered to pend, send orders by protocol, or operationalize verbal orders, may compose 25% of the orders from start to finish on their own, while the rest are pended or completed by team members for the physician’s co-signature. In this case, TWORD = 75%.
Undivided attention	ATTN	The amount of undivided attention patients receive from their physician. It is approximated by [(total time per session) minus (EHR time per session)]/total time per session.
		Example: A physician who is actively on the EHR 3 h of a 4-h clinic session would have a lower ATTN score (4-3)/4 = 0.25 than would a physician who was actively on the EHR 1 h of a 4-h clinic session. (4-1)/4 = 0.75.

EHR: electronic health record.

^aFor consistency, and to avoid distortion owing to different session lengths, we define work outside of work precisely as that time outside of scheduled patient hours and do not include any “shoulder time” before or after clinic.