Abstract
Background As electronic health record (EHR) use becomes more widespread, detailed records of
how users interact with the EHR, known as EHR audit logs, are being used to characterize
the clinical workflows of physicians including residents. After-hours EHR use is of
particular interest given its known association with physician burnout. Several studies
have analyzed EHR audit logs for residents in other fields, such as internal medicine,
but none thus far in ophthalmology. Here, we focused specifically on EHR use during
on-call shifts outside of normal clinic hours.
Methods In this retrospective study, we analyzed raw EHR audit log data from on-call shifts
for 12 ophthalmology residents at a single institution over the course of a calendar
year. Data were analyzed to characterize total time spent using the EHR, clinical
volume, diagnoses of patients seen on call, and EHR tasks.
Results Across all call shifts, the median and interquartile range (IQR) of the time spent
logged into the EHR per shift were 88 and 131 minutes, respectively. The median (IQR)
unique patient charts accessed per shift was 7 (9) patients. When standardized to
per-hour measures, weekday evening shifts were the busiest call shifts with regard
to both EHR use time and clinical volume. Total EHR use time and clinical volume were
greatest in the summer months (July to September). Chart review comprised a majority
(63.4%) of ophthalmology residents' on-call EHR activities.
Conclusion In summary, EHR audit logs demonstrate substantial call burden for ophthalmology
residents outside of regular clinic hours. These data and future studies can be used
to further characterize the clinical exposure and call burden of ophthalmology residents
and could potentially have broader implications in the fields of physician burnout
and education policy.
Keywords
electronic health records - audit logs - ophthalmology residents - call burden - clinical
activity - EHR tasks - education policy
