Department of Neurosurgery, Stanford University Medical Center, Stanford, California.
Stanford Health Care, Stanford, California.
JAMA Netw Open. 2024 Jul 1;7(7):e2421717. doi: 10.1001/jamanetworkopen.2024.21717.
Understanding gender differences in electronic health record (EHR) use among surgeons is crucial for addressing potential disparities in workload, compensation, and physician well-being.
To investigate gender differences in EHR usage patterns.
DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study examined data from an EHR system (Epic Signal) at a single academic hospital from January to December 2022. Participants included 224 attending surgeons with patient encounters in the outpatient setting. Statistical analysis was performed from May 2023 to April 2024.
Surgeon's gender.
The primary outcome variables were progress note length, documentation length, time spent in medical records, and time spent documenting patient encounters. Continuous variables were summarized with median and IQR and assessed via the Kruskal-Wallis test. Categorical variables were summarized using proportion and frequency and compared using the χ2 test. Multivariate linear regression was used with primary EHR usage variables as dependent variables and surgeon characteristics as independent variables.
This study included 222 529 patient encounters by 224 attending surgeons, of whom 68 (30%) were female and 156 (70%) were male. The median (IQR) time in practice was 14.0 (7.8-24.3) years. Male surgeons had more median (IQR) appointments per month (78.3 [39.2-130.6] vs 57.8 [25.7-89.8]; P = .005) and completed more medical records per month compared with female surgeons (43.0 [21.8-103.9] vs 29.1 [15.9-48.1]; P = .006). While there was no difference in median (IQR) time spent in the EHR system per month (664.1 [301.0-1299.1] vs 635.0 [315.6-1192.0] minutes; P = .89), female surgeons spent more time logged into the system both outside of 7am to 7pm (36.4 [7.8-67.6] vs 14.1 [5.4-52.2] min/mo; P = .05) and outside of scheduled clinic hours (134.8 [58.9-310.1] vs 105.2 [40.8-214.3] min/mo; P = .05). Female surgeons spent more median (IQR) time per note (4.8 [2.6-7.1] vs 2.5 [0.9-4.2] minutes; P < .001) compared with male surgeons. Male surgeons had a higher number of median (IQR) days logged in per month (17.7 [13.8-21.3] vs 15.7 [10.7-19.7] days; P = .03). Female surgeons wrote longer median (IQR) inpatient progress notes (6025.1 [3692.1-7786.7] vs 4307.7 [2808.9-5868.4] characters/note; P = .001) and had increased outpatient document length (6321.1 [4079.9-7825.0] vs 4445.3 [2934.7-6176.7] characters/note; P < .001). Additionally, female surgeons wrote a higher fraction of the notes manually (17% vs 12%; P = .006). After using multivariable linear regression models, male gender was associated with reduced character length for both documentations (regression coefficient, -1106.9 [95% CI, -1981.5 to -232.3]; P = .01) and progress notes (regression coefficient, -1119.0 [95% CI, -1974.1 to -263.9]; P = .01). Male gender was positively associated with total hospital medical records completed (regression coefficient, 47.3 [95% CI, 28.3-66.3]; P < .001). There was no difference associated with gender for time spent in each note, time spent outside of 7 am to 7 pm, or time spent outside scheduled clinic hours.
This cross-sectional study of EHR data found that female surgeons spent more time documenting patient encounters, wrote longer notes, and spent more time in the EHR system compared with male surgeons. These findings have important implications for understanding the differential burdens faced by female surgeons, including potential contributions to burnout and payment disparities.
重要性：了解外科医生在电子病历 (EHR) 使用方面的性别差异对于解决潜在的工作量、薪酬和医生健康方面的差异至关重要。
目的：调查 EHR 使用模式中的性别差异。
设计、地点和参与者：这项横断面研究使用来自 2022 年 1 月至 12 月期间单一学术医院的 Epic Signal 电子病历系统的数据。参与者包括 224 名有门诊就诊患者的主治外科医生。统计分析于 2023 年 5 月至 2024 年 4 月进行。
暴露因素：外科医生的性别。
主要结果和措施：主要的结果变量是病程记录的长度、文档长度、在医疗记录中花费的时间和记录患者就诊花费的时间。连续变量采用中位数和四分位距进行总结，并通过 Kruskal-Wallis 检验进行评估。分类变量采用比例和频率进行总结，并通过 χ2 检验进行比较。使用多元线性回归，将主要的 EHR 使用变量作为因变量，外科医生的特征作为自变量。
结果：这项研究包括 222529 名由 224 名主治外科医生治疗的患者就诊，其中 68 名（30%）为女性，156 名（70%）为男性。中位（IQR）行医年限为 14.0（7.8-24.3）年。男性外科医生的每月预约次数（78.3[39.2-130.6]比 57.8[25.7-89.8]；P=0.005）和每月完成的医疗记录数量（43.0[21.8-103.9]比 29.1[15.9-48.1]；P=0.006）均多于女性外科医生。尽管每月在 EHR 系统中花费的时间中位数（IQR）没有差异（664.1[301.0-1299.1]比 635.0[315.6-1192.0]分钟；P=0.89），但女性外科医生在 7 点至 7 点以外的时间（36.4[7.8-67.6]比 14.1[5.4-52.2]分钟/月；P=0.05）和预约门诊时间以外的时间（134.8[58.9-310.1]比 105.2[40.8-214.3]分钟/月；P=0.05）登录系统的时间更长。女性外科医生记录每份病程记录的时间中位数（IQR）更长（4.8[2.6-7.1]比 2.5[0.9-4.2]分钟；P<0.001）。男性外科医生每月登录天数的中位数（IQR）更高（17.7[13.8-21.3]比 15.7[10.7-19.7]天；P=0.03）。女性外科医生记录的住院病程记录中位数（IQR）更长（6025.1[3692.1-7786.7]比 4307.7[2808.9-5868.4]字符/记录；P=0.001），门诊文档长度中位数（IQR）也更长（6321.1[4079.9-7825.0]比 4445.3[2934.7-6176.7]字符/记录；P<0.001）。此外，女性外科医生手动记录的笔记比例更高（17%比 12%；P=0.006）。使用多变量线性回归模型后，男性性别与文档长度（回归系数，-1106.9[95%CI，-1981.5 至-232.3]；P=0.01）和病程记录长度（回归系数，-1119.0[95%CI，-1974.1 至-263.9]；P=0.01）呈负相关。男性性别与完成的总医院病历数量呈正相关（回归系数，47.3[95%CI，28.3-66.3]；P<0.001）。性别与在每个记录中花费的时间、7 点到 7 点以外的时间或预约门诊时间以外的时间没有差异。
结论和意义：这项对 EHR 数据的横断面研究发现，与男性外科医生相比，女性外科医生花费更多的时间记录患者就诊，记录更长的病程记录，并且在 EHR 系统中花费更多的时间。这些发现对理解女性外科医生面临的差异负担具有重要意义，包括潜在的倦怠和薪酬差异贡献。
