Characterizing electronic health record usage patterns of inpatient medicine residents using event log data
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Abstract
Amid growing rates of burnout, physicians report increasing electronic health record (EHR) usage alongside decreasing clinical facetime with patients. There exists a pressing need to improve physician-computer-patient interactions by streamlining EHR workflow. To identify interventions to improve EHR design and usage, we systematically characterize EHR activity among internal medicine residents at a tertiary academic hospital across various inpatient rotations and roles from June 2013 to November 2016. Logged EHR timestamps were extracted from Stanford Hospital's EHR system (Epic) and cross-referenced against resident rotation schedules. We tracked the quantity of EHR logs across 24-hour cycles to reveal daily usage patterns. In addition, we decomposed daily EHR time into time spent on specific EHR actions (e.g. chart review, note entry and review, results review).In examining 24-hour usage cycles from general medicine day and night team rotations, we identified a prominent trend in which night team activity promptly ceased at the shift's end, while day team activity tended to linger post-shift. Across all rotations and roles, residents spent on average 5.38 hours (standard deviation = 2.07) using the EHR. PGY1 (post-graduate year one) interns and PGY2+ residents spent on average 2.4 and 4.1 times the number of EHR hours on information review (chart, note, and results review) as information entry (note and order entry).Analysis of EHR event log data can enable medical educators and programs to develop more targeted interventions to improve physician-computer-patient interactions, centered on specific EHR actions.
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The 5-minute idle time threshold has been used in several studies analyzing raw log data.
“Notably, this threshold has been used in several studies analyzing raw log data.24,25,31,46,47”
From Electronic health record activity changes around new decision support implementation: monitoring using audit logs and topic modeling (2025) · cites this paper as [25]
Audit logs capture EHR-use behavior without interruptions.
“Third, audit logs capture EHR-use behavior without interruptions.”
From Electronic health record activity changes around new decision support implementation: monitoring using audit logs and topic modeling (2025) · cites this paper as [25]
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Moy, A. J., Schwartz, J. M., Chen, R., Sadri, S., Lucas, E., Cato, K. D., & Rossetti, S. C. (2021) · Journal of the American Medical Informatics Association · doi:10.1093/jamia/ocaa325 · Cited by 284 · see citing works
Interaction time with electronic health records: a systematic review
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Self-citation
- Authors
- Wang, J. K., Ouyang, D., Hom, J., Chi, J., & Chen, J. H.
- Affiliations
- Stanford University (US)
- Stanford Medicine (US)
- Venue
- PLOS ONE
- Publisher
- Public Library of Science (PLoS)
- Published
- 2019-02-06
- Volume
- 14
- Issue
- 2
- Pages
- e0205379
- ISSN
- 1932-6203 (ISSN-L)
- PMC
- PMC6364867
- OpenAlex
- W2912878510
- Cited by
- 63
- References
- 3
- Citations by year
- 2026: 6 · 2025: 5 · 2024: 4 · 2023: 9 · 2022: 9 · 2021: 9 · 2020: 15 · 2019: 5
- FWCI
- 10.37
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- PLoS ONE (publishedVersion, cc-by)
- bioRxiv (Cold Spring Harbor Laboratory) (acceptedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Funders
- National Institutes of Health
- National Institute of Environmental Health Sciences (K01ES026837)
- National Center for Research Resources (UL1RR025744)
- Topics
- Health Sciences › Health Professions › Health Information Management › Electronic Health Records Systems
- Health Sciences › Medicine › Emergency Medicine › Hospital Admissions and Outcomes
- Health Sciences › Nursing › Issues, ethics and legal aspects › Nursing Diagnosis and Documentation
- Keywords
- electronic health records, internal medicine residents, physician burnout, event logs
- MeSH terms
- Academic Medical Centers, Humans, Inpatients, Internal Medicine, Internship and Residency, Practice Patterns, Physicians', Physicians, Time Factors, Photoperiod, Electronic Health Records, Tertiary Care Centers
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