Albert Einstein College of Medicine, Bronx, New York, United States.
Department of Urology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, United States.
Appl Clin Inform. 2024 Jan;15(1):34-44. doi: 10.1055/a-2194-1061. Epub 2023 Oct 18.
This study aimed to utilize metrics from physician action logs to analyze surgeon clinical, volume, electronic health record (EHR) efficiency, EHR proficiency, and workload outside scheduled time as impacted by physician characteristics such as years of experience, gender, subspecialty, academic title, and administrative title.
We selected 30 metrics from Epic Signal, an analytic tool in Epic that extracts metrics related to clinician documentation. Metrics measuring appointments, messages, and scheduled hours per day were used as a correlate for volume. EHR efficiency, and proficiency were measured by scores built into Epic Signal. Metrics measuring time spent in the EHR outside working hours were used as a correlate for documentation burden. We analyzed these metrics among surgeons at our institution across 4 months and correlated them with physician characteristics.
Analysis of 133 surgeons showed that, when stratified by gender, female surgeons had significantly higher EHR metrics for time per day, time per appointment, and documentation burden, and significantly lower EHR metrics for efficiency when compared to male surgeons. When stratified by experience, surgeons with 0 to 5 years of experience had significantly lower EHR metrics for volume, time per day, efficiency, and proficiency when compared to surgeons with 6 to 10 and more than 10 years of experience. On multivariate analysis, having over 10 years of experience was an independent predictor of more appointments per day, greater proficiency, and spending less time per completed message. Female gender was an independent predictor of spending more time in notes per appointment and time spent in the EHR outside working hours.
The burden associated with volume, proficiency, efficiency, and workload outside scheduled time related to EHR use varies by gender and years of experience in our cohort of surgeons. Evaluation of physician action logs could help identify those at higher risk of burnout due to burdensome medical documentation.
本研究旨在利用医生行为日志中的指标，分析外科医生的临床、工作量、电子病历（EHR）效率、EHR 熟练度以及在预定时间之外的工作负荷，这些因素受医生特征（如工作年限、性别、亚专业、职称和行政职称）的影响。
我们从 Epic Signal 中选择了 30 个指标，这是 Epic 中的一个分析工具，可提取与临床医生记录相关的指标。用于衡量工作量、EHR 效率和熟练度的指标是根据每日预约、消息和预定时间计算得出的。EHR 效率和熟练度通过 Epic Signal 中的分数来衡量。用于衡量在工作时间之外在 EHR 中花费的时间的指标是作为记录负担的相关指标。我们在我院对 4 个月的外科医生进行了分析，并将这些指标与医生特征相关联。
对 133 名外科医生的分析表明，按性别分层时，与男性外科医生相比，女性外科医生每天的 EHR 时间、每次预约的时间和记录负担的 EHR 指标明显更高，而效率的 EHR 指标明显更低。按经验分层时，与具有 6-10 年和 10 年以上经验的外科医生相比，具有 0-5 年经验的外科医生的 EHR 指标在工作量、每天的时间、效率和熟练度方面明显较低。多变量分析显示，具有 10 年以上经验是每天预约次数增加、熟练度更高和每条完成的消息花费时间减少的独立预测因素。女性是每次预约时记录更多时间和工作时间外花在 EHR 上的时间的独立预测因素。
在我们的外科医生队列中，与 EHR 使用相关的工作量、熟练度、效率和预定时间之外的工作负荷的负担因性别和工作年限而异。对医生行为日志的评估可以帮助确定那些由于繁琐的医疗记录而面临更高倦怠风险的人。
