Provider Experience with EHRs 

Measuring Patient Scheduled Hours per Full Time Physician by Specialty and Identifying Modifying Factors
Sponsor: The American Medical Association

Increasing physician workload that falls outside of patient encounter time is widespread, with consequences that include burnout and dissatisfaction with work-life integration.  Given financial pressures to maintain high encounter volumes, especially in ambulatory specialties such as family medicine, internal medicine and geriatrics, this workload typically spills into time outside of the scheduled workday (“work outside of work”, or WOW). When WOW is predominantly comprised of administrative and documentation activities that feel low value, it compounds the contribution of WOW to burnout and dissatisfaction.  While efforts to reduce low-value documentation are underway, there will remain a significant amount of administrative and documentation work that is valuable.  Thus, it is critical to formally recognize and account for WOW as part of role and work hours expectations.  To better understand how much time is spent by physicians working outside of patient scheduled hours, UCSF will leverage a large-scale, national dataset to measure Patient Scheduled Hours (PSH) and WOW as captured by EHR time occurring after the last scheduled encounter. The study team will assess the ratio of WOW to PSH and then use it to calculate how many PSH would result in a 40-hour work week (PSH40) overall and by specialty. The team will also identify factors that explain variation in the ratio of WOW to PSH overall and by specialty.

Evaluation of the Impact of Evaluation and Management Coding Changes on Physician Time Spent on Documentation and Burnout
Sponsor: The American Medical Association

To reduce EHR documentation burden, CMS changed documentation requirements for E&M encounters, with large-scale changes going into effect in 2021. The goal of this project is to conduct a comprehensive assessment of the impact of these changes on EHR time, EHR use patterns, and physician burnout. We will partner with Cerner to assess changes in a national sample and complement this with a deep dive into the experiences of UCSF physicians, including assessment of changes in validated measures of burnout.

Differences in Ambulatory EHR Use Patterns for Male vs. Female Physicians

Widespread adoption of electronic health records (EHRs) has transformed patient care. While  prior studies have linked EHR use to physician burnout, understanding different approaches to EHR use facilitates a more nuanced understanding of this relationship. Prior work has revealed that physician gender is tied to burnout as well as to patient expectations and outcomes. Therefore, in this study, we sought to understand differences in EHR use patterns — across an array of measures related to time spent on documentation, approaches to EHR documentation, and use of EHR tools — by physician gender for all ambulatory physicians (n = 1,336) at a large academic medical center. 

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