Yale researchers dig into EHR use data – and gender differences
While the shift to electronic health records (EHR) in the medical profession was supposed to improve the quality and efficiency of healthcare for doctors and patients alike, many physicians have given the technology low grades.
A new Yale study digs into the data on how physicians are using EHRs, including how time spent using the systems differs by specialty, and what these findings reveal about how the technology can be improved.
One of the key findings is that female physicians spend an average of 30 minutes more per day using EHRs than their male colleagues. The results were published April 5 in the Journal of the American Medical Informatics Association. A related article appeared the same day in JAMA Network.
“Now that we’re measuring EHR use more reliably, the finding about female physicians spending more time on the EHR than male physicians likely is just the tip of the iceberg in terms of how the EHR is not meeting users’ needs,” said lead author Dr. Ted Melnick, associate professor of emergency medicine and biostatistics at Yale.
Over the past decade, the healthcare industry has become increasingly digitized to promote quality, efficiency, and outcomes. In many ways, EHR technologies, which are used by the majority of U.S. doctors, have transformed medical care. They allow for inputting all patient information in digital charts, ordering prescriptions, and tracking changes. However, they have also added significantly to doctors’ workloads and led to burnout, Melnick says.
In a 2019 study, published in the journal Mayo Clinic Proceedings, he found that the majority of physicians surveyed gave their EHRs an “F” rating for usability, and that the rating correlated with burnout.
Last year the American Medical Association provided funding that allowed Melnick to measure core efficiencies of EHR technologies in seven areas proposed by a group of physicians: total EHR time spent during an eight-hour shift, work done outside of standard work hours, documenting patient health, documenting prescriptions, responding to emails, coordinating medical orders, and undivided attention given to patients.
The ensuing study was the first to apply standard measurements across EHR systems using different vendor products — specifically, Yale New Haven Health (which uses the Epic medical software) and Medstar (a Washington, D.C.-area health system which uses technology from the Cerner Corporation). It incorporated data from 573 physicians across multiple specialties.
According to the analysis, there was substantial variation in time spent on the EHR based on specialty. The most time was spent by doctors in gastroenterology, internal medicine, and family medicine. The least time was spent by doctors in the surgical specialties, sports medicine, neurology/psychiatry, and obstetrics/gynecology.
After controlling for physician age, specialty, vendor, and number of hours worked, there was also a significant gender difference in EHR use, with female physicians spending an additional 30 minutes per day on EHRs. It’s not clear what is driving this difference, Melnick said, but it’s a finding he wants to explore.
“This finding is so compelling because it suggests that female physicians interact with the EHR in a different way than male physicians do,” he said. “We don't know what it is, but now that we have a way to measure it and identify it, we can begin to understand it better and hopefully build systems that address those needs.”
The latest study noted that although there are still challenges in standardizing data from different EHRs, the consistent findings around time spent by specialty and gender suggest that there are important lessons to be learned about how EHRs are used and how they can be improved.
“Measurement in this space is going to be really important,” Melnick said. “As opposed to us as academics saying ‘This is what the vendor should be doing,’ or vendors delivering dashboards, saying, ‘Here's your data,’ we need to engage all stakeholders and really start to think about the measures that are going to be meaningful to each group so that we can harness this metadata in a meaningful way to all stakeholders.”