Novel Nonproprietary Measures of Ambulatory Electronic Health Record Use Associated with Physician Work Exhaustion

Appl Clin Inform. 2021 May;12(3):637-646. doi: 10.1055/s-0041-1731678. Epub 2021 Jul 14.


Background: Accumulating evidence indicates an association between physician electronic health record (EHR) use after work hours and occupational distress including burnout. These studies are based on either physician perception of time spent in EHR through surveys which may be prone to bias or by utilizing vendor-defined EHR use measures which often rely on proprietary algorithms that may not take into account variation in physician's schedules which may underestimate time spent on the EHR outside of scheduled clinic time. The Stanford team developed and refined a nonproprietary EHR use algorithm to track the number of hours a physician spends logged into the EHR and calculates the Clinician Logged-in Outside Clinic (CLOC) time, the number of hours spent by a physician on the EHR outside of allocated time for patient care.

Objective: The objective of our study was to measure the association between CLOC metrics and validated measures of physician burnout and professional fulfillment.

Methods: Physicians from adult outpatient Internal Medicine, Neurology, Dermatology, Hematology, Oncology, Rheumatology, and Endocrinology departments who logged more than 8 hours of scheduled clinic time per week and answered the annual wellness survey administered in Spring 2019 were included in the analysis.

Results: We observed a statistically significant positive correlation between CLOC ratio (defined as the ratio of CLOC time to allocated time for patient care) and work exhaustion (Pearson's r = 0.14; p = 0.04), but not interpersonal disengagement, burnout, or professional fulfillment.

Conclusion: The CLOC metrics are potential objective EHR activity-based markers associated with physician work exhaustion. Our results suggest that the impact of time spent on EHR, while associated with exhaustion, does not appear to be a dominant factor driving the high rates of occupational burnout in physicians.

MeSH terms

  • Ambulatory Care Facilities
  • Burnout, Professional*
  • Electronic Health Records*
  • Humans
  • Physicians*
  • Surveys and Questionnaires

Grant support

Funding None.