Physician note composition patterns and time on the EHR across specialty types: a national, cross-sectional study.
Open accessAbstract
Background The burden of clinical documentation in electronic health records (EHRs) has been associated with physician burnout. Numerous tools (e.g., note templates and dictation services) exist to ease documentation burden, but little evidence exists regarding how physicians use these tools in combination and the degree to which these strategies correlate with reduced time spent on documentation.Objective To characterize EHR note composition strategies, how these strategies differ in time spent on notes and the EHR, and their distribution across specialty types.Design Secondary analysis of physician-level measures of note composition and EHR use derived from Epic Systems' Signal data warehouse. We used k-means clustering to identify documentation strategies, and ordinary least squares regression to analyze the relationship between documentation strategies and physician time spent in the EHR, on notes, and outside scheduled hours.Participants A total of 215,207 US-based ambulatory physicians using the Epic EHR between September 2020 and May 2021.Main measures Percent of note text derived from each of five documentation tools: SmartTools, copy/paste, manual text, NoteWriter, and voice recognition and transcription; average total and after-hours EHR time per visit; average time on notes per visit.Key results Six distinct note composition strategies emerged in cluster analyses. The most common strategy was predominant SmartTools use (n=89,718). In adjusted analyses, physicians using primarily transcription and dictation (n=15,928) spent less time on notes than physicians with predominant Smart Tool use. (b=-1.30, 95% CI=-1.62, -0.99, p<0.001; average 4.8 min per visit), while those using mostly copy/paste (n=23,426) spent more time on notes (b=2.38, 95% CI=1.92, 2.84, p<0.001; average 13.1 min per visit).Conclusions Physicians' note composition strategies have implications for both time in notes and after-hours EHR use, suggesting that how physicians use EHR-based documentation tools can be a key lever for institutions investing in EHR tools and training to reduce documentation time and alleviate EHR-associated burden.
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Specialists may still need to manually add these sections to the progress note after ambient AI generation, which may require time and increase total length.
“Specialists may still need to manually add these sections to the progress note after ambient AI generation, which may require time and increase total length.24”
From Evaluation of an Ambient Artificial Intelligence Documentation Platform for Clinicians (2025) · cites this paper as [24]
The Discussion says specialists use notes to convey clinical reasoning and longitudinal data, while the Results associate manual entry with more time on notes and copy/paste with longer notes. The paper does not study ambient AI generation or say specialists must add sections afterward, so it cannot establish the proposed workflow or its effect on note length. (LLM, conf=0.84)
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- Authors
- Rotenstein, L. S., Apathy, N., Holmgren, A. J., & Bates, D. W.
- Affiliations
- Brigham and Women's Hospital (US)
- Regenstrief Institute (US)
- University of California, San Francisco (US)
- Corresponding author
- Rotenstein, Lisa S.
- Venue
- Journal of General Internal Medicine
- Published
- 2022-11-23
- Volume
- 38
- Issue
- 5
- Pages
- 1119-1126
- ISSN
- 0884-8734 (ISSN-L)
- 1525-1497
- PMC
- PMC10110827
- OpenAlex
- W4309885534
- Cited by
- 28
- References
- 27
- Citations by year
- 2026: 10 · 2025: 11 · 2024: 5 · 2023: 2
- FWCI
- 3.37
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Journal of General Internal Medicine (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Health Professions › Health Information Management › Electronic Health Records Systems
- Health Sciences › Nursing › Issues, ethics and legal aspects › Nursing Diagnosis and Documentation
- Health Sciences › Health Professions › Health Information Management › Medical Coding and Health Information
- Keywords
- clinical documentation, electronic health records, physician burnout, documentation burden, copy and paste, specialty differences
- MeSH terms
- Cross-Sectional Studies, Documentation, Humans, Physicians, Cluster Analysis, Electronic Health Records
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