Unlocking Inpatient Workload Insights with Electronic Health Record Event Logs
Open accessAbstract
High workloads in inpatient settings are associated with clinician burnout and have the potential to negatively impact patient care and the overall performance of organizations.1, 2 However, the workload thresholds at which these effects occur are unclear, with a notable lack of evidence-based guidance for optimizing work design in inpatient settings. Conventional measures of workload (i.e., work relative value units [wRVUs] and volume of patient encounters) are typically used to capture measures of patient-related workloads but inadequately capture the full work effort or the impact of workloads on key outcomes.3 To address the research to practice re-design gap, an emerging field offers promise: the use of electronic health record (EHR) event logs to understand how work design—which includes strategies around deriving optimal workloads and team structures—influences work patterns and, subsequently, patient outcomes.4, 5 EHR event logs represent a wealth of data, recording various aspects of clinical work activities and flow of events based on actions performed within the EHR.6 Event log data are unique as they are user-based (as opposed to clinical data that are patient-based) and capture the sequence of clinician care workflows that are typically not part of traditional medical record data elements.7 Major EHR vendors have now developed within-EHR platforms (e.g., Epic's Signal) that aggregate event log data into operational measures of clinician work (e.g., time spent on notes) making the data accessible to organizational leaders. To date, considerable research has used event log data to quantify workload and work patterns in the outpatient setting.8-10 National organizations, such as the American Medical Association, are encouraging the use of EHR-based measures in practice transformation efforts to improve clinician well-being and reduce burnout.11 Although there has been much excitement in the outpatient space, the use of event logs in inpatient settings has been limited to a handful of studies.12-15 In this perspective, we identify EHR event log measures relevant to inpatient clinician work, describe challenges with its use, and propose innovative use cases for future work. In outpatient settings, Sinsky et al. identified seven core measures for assessing practice efficiency through EHR event logs10; however, inpatient clinician workflows are considerably different from outpatient settings. Recognizing the need for tailored measures to capture the unique demands and dynamics in inpatient settings, our authorship team, consisting of clinician experts in the inpatient setting and outpatient setting and experts in clinical informatics, derived potential measures for use in the field of hospital medicine (i.e., generalist, nonsurgical) given the limited prior applications of such measures in inpatient settings. Our selection process involved considering the work conducted by Sinsky et al.10 while also considering the distinct differences and challenges faced by inpatient clinicians, such as shift structures, patient encounters that often last for days/weeks (i.e., inpatient stays), communication patterns, structures of teams, interruptions, and the dynamic nature of the work environment. The proposed measures were also reviewed by a group of national experts on clinician workload. Table 1 shows the proposed measures, descriptions, nuances, challenges, and limitations for each measure. This work serves as a starting point for future research and discussion around the most salient measures using event log data and to bring awareness regarding the utility of this data that is available in all modern EHRs. Future efforts should focus on refining, standardizing, and prioritizing these measures. With potential measures defined, the use cases for event log data in the inpatient setting are immense and include practice management, educational, and quality improvement purposes in addition to research; however, efforts in these areas outside of research settings are sparse. Within the realm of practice management, event log data have the potential to support evidence-based work design practices. As clinicians in the inpatient setting continue to face pressures to increase the volume of patient encounters,2, 16 event log-based measures paired with critical workforce, patient, and organizational outcomes may offer pragmatic practice insights. These insights could help organizational leaders understand when work design and workloads may contribute to harm. For example, if certain workload thresholds, as measured by event logs—such as number of patient encounters, secure messages sent or received, or EHR-based interruptions (e.g., alerts, messages)—are found to be associated with burnout or patient harm, then these thresholds could be monitored and proactively addressed. Early research has indicated that conducting ecological assessments through carefully timed clinician surveys can provide valuable insights into how
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Diagnostic processes differ across care settings in terms of workflow, communication needs, and resources.
“Since diagnostic processes differ across care settings in terms of workflow, communication needs, and resources, organizational strategies for diagnostic safety should be tailored to each specific setting [373,374].”
From Toward Safer Diagnoses: A SEIPS-Based Narrative Review of Diagnostic Errors (2026) · cites this paper as [373]
In “Defining the Measures” (page unavailable), the paper says inpatient workflows differ considerably from outpatient workflows, including in communication patterns and team structures. It discusses tailoring EHR event-log measures to inpatient work, but does not establish that diagnostic processes differ across settings in their resource needs. (LLM, conf=0.84)
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Self-citation
- Authors
- Burden, M., Keniston, A., Pell, J., Yu, A., Dyrbye, L., & Kannampallil, T.
- Affiliations
- University of Colorado Anschutz (US)
- Washington University in St. Louis (US)
- Corresponding author
- Burden, Marisha
- Venue
- Journal of Hospital Medicine
- Publisher
- Wiley
- Published
- 2024-05-05
- Volume
- 20
- Issue
- 1
- Pages
- 79-84
- ISSN
- 1553-5592 (ISSN-L)
- 1553-5606
- PMC
- PMC11696819
- OpenAlex
- W4396656705
- Cited by
- 19
- References
- 23
- Citations by year
- 2026: 6 · 2025: 8 · 2024: 5
- FWCI
- 5.81
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- Journal of Hospital Medicine (publishedVersion, cc-by-nc)
- PubMed Central (publishedVersion, cc-by-nc)
- PubMed (publishedVersion)
- Funders
- American Medical Association (EHR Use Research Grant)
- Agency for Healthcare Research and Quality (1R01HS29020)
- Topics
- Health Sciences › Health Professions › Health Information Management › Electronic Health Records Systems
- Health Sciences › Health Professions › General Health Professions › Healthcare professionals’ stress and burnout
- Health Sciences › Medicine › Emergency Medicine › Hospital Admissions and Outcomes
- Keywords
- clinician burnout, job design, hospital medicine, clinical workflow, clinician well-being, work patterns, team structure, research-practice gap, clinician engagement, clinician education and training
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