Have you got the time? Challenges using vendor electronic health record metrics of provider efficiency
Open accessAbstract
The rise of clinician burnout has been correlated with the increased adoption of electronic health records (EHRs). Some vendors have used data entry logs to measure the amount of time spent using the EHR and have developed metrics of provider efficiency. Initial attempts to utilize these data have proven difficult as it is not always apparent whether variations reflect provider behavior or simply the metric definitions. Metric definitions are also updated intermittently without warning, making longitudinal assessment problematic. Because the metrics are based on proprietary algorithms, they are impossible to validate without costly time-motion studies and are also difficult to compare across institutions and vendors. Clinical informaticians must partner with vendors in order to develop industry standards of EHR use, which could then be used to examine the impact of EHRs on clinician burnout.
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Such metrics track time spent on predefined high-level EHR activities but lose fine-grained contextual information.
“Such metrics track time spent on predefined high-level EHR activities (eg, order entry, chart review, note review), but lose fine-grained contextual information.”
From Electronic health record activity changes around new decision support implementation: monitoring using audit logs and topic modeling (2025) · cites this paper as [35]
Cites
Arndt, B. G., Beasley, J. W., Watkinson, M. D., Temte, J. L., Tuan, W.-J., Sinsky, C. A., & Gilchrist, V. J. (2017) · The Annals of Family Medicine · doi:10.1370/afm.2121 · Cited by 972 · cited 1× · see citing works
“Increased burnout among physicians has been linked to the rise of the EHR and the increasing administrative burden placed on providers.(3) While the EHR does not inherently create additional work for providers,(4) it does provide a platform to more easily enforce regulatory requirements.”
BackgroundPhysician Burnout in the Electronic Health Record Era: Are We Ignoring the Real Cause?
Downing, N. L., Bates, D. W., & Longhurst, C. A. (2018) · Annals of Internal Medicine · doi:10.7326/m18-0139 · Cited by 418 · see citing works
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Temporal Associations Between EHR-Derived Workload, Burnout, and Errors: a Prospective Cohort Study
Lou, S. S., Lew, D., Harford, D. R., Lu, C., Evanoff, B. A., Duncan, J. G., & Kannampallil, T. (2022) · Journal of General Internal Medicine · doi:10.1007/s11606-022-07620-3 · Cited by 46 · see citing works
Lou, S. S., Liu, H., Harford, D., Lu, C., & Kannampallil, T. (2023) · Journal of the American Medical Informatics Association · doi:10.1093/jamia/ocac239 · Cited by 13 · see citing works
Explaining Variability in Electronic Health Record Effort in Primary Care Ambulatory Encounters
Overhage, J. M., Qeadan, F., Choi, E. H. E., Vos, D., & Kroth, P. J. (2024) · Applied Clinical Informatics · doi:10.1055/s-0044-1782228 · Cited by 13 · see citing works
Chen, J., Cutrona, S. L., Dharod, A., Moses, A., Bridges, A., Ostasiewski, B., Foley, K. L., Houston, T. K., iDAPT (Implementation & Informatics Developing Adaptable Processes and Technologies for Cancer Control) Implementation Science Center for Cancer Control, Chen, J., et al. (2025) · JAMIA Open · doi:10.1093/jamiaopen/ooaf050 · Cited by 3 · see citing works
- Authors
- Hron, J. D., & Lourie, E.
- Affiliations
- Boston Children's Hospital (US)
- Children's Hospital of Philadelphia (US)
- Corresponding author
- Hron, Jonathan D
- Venue
- Journal of the American Medical Informatics Association
- Publisher
- Oxford University Press (OUP)
- Published
- 2020-02-04
- Volume
- 27
- Issue
- 4
- Pages
- 644-646
- ISSN
- 1067-5027 (ISSN-L)
- 1527-974X
- PMC
- PMC7647287
- OpenAlex
- W3006426907
- Cited by
- 27
- References
- 2
- Citations by year
- 2025: 4 · 2024: 3 · 2023: 2 · 2022: 6 · 2021: 7 · 2020: 5
- FWCI
- 4.91
- Type
- journal article
- Language
- en
- Open access
- green
- europepmc.org
- Licence
- academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model (vor)
- Locations
- Journal of the American Medical Informatics Association (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Health Professions › Health Information Management › Electronic Health Records Systems
- Health Sciences › Health Professions › Health Information Management › Medical Coding and Health Information
- Health Sciences › Nursing › Issues, ethics and legal aspects › Nursing Diagnosis and Documentation
- Keywords
- electronic health records, clinician burnout, metric validation, metric standardization, EHR adoption, time and motion study
- MeSH terms
- Burnout, Professional, Commerce, Efficiency, Humans, Efficiency, Organizational, Benchmarking, Electronic Health Records
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