Electronic health record (EHR) use research

Electronic health record (EHR) use research

Electronic health records (EHR) systems are an important tool in providing patient care. While they provide many benefits, EHR use is also fraught with issues driven by excessive tasks and inbox volume, workflow interruptions, and poor interoperability. Burdens resulting from EHR use are known contributors to physician burnout. Over the past decade, the AMA has worked with researchers across the U.S. to expand insight into EHR systems and measure the technologies’ capacity to support or undermine the delivery of efficient and effective clinical work.

Rigorous research continues to advance the science on the use of EHR audit log data, transactional data, or other EHR user data to identify patterns in EHR use that may detract from patient care or EHR efficiency; contribute to burnout, stress or attitudinal shifts related to work and career; or may inform decisions about workflows, teamwork, and resource allocation at the practice level. This research allows the AMA to partner with other institutions to meaningfully grow the body of knowledge on EHR use metrics. 

Past AMA-funded research

The research funded by the AMA set out to explore and test what, at the time, were relatively new metrics for measuring physician activity in the EHR. The metrics were identified and explained in the publication “Novel Metrics for Improving Professional Fulfillment” and further discussed in the article “Metrics for assessing physician activity using electronic health record log data.” These metrics served as the foundation for most of the research studies funded by the AMA and have become standard across stakeholders in the pursuit of effective and comparable measurement of EHR use. 

Research supported by the AMA has been published in leading journals on a variety of related topics and has contributed valuable and influential insights to the field. Highlights of published findings include: 

• This study’s results suggest that secure messaging use is associated with clinician work behaviors, potentially contributing to increased workload and cognitive burden (Lew, 2025).
• This study examines the relationship between clinician attestation of problem and medication list reviews and the length and accuracy of these lists. Findings suggested that attestation may be a “check-the-box” activity, rather than an indicator of shorter, less duplicative lists. There was no significant correlation between list length or duplication and attestation. Additionally, clinicians reported a high cognitive burden when reviewing these lists (Simon, 2025).
• This study quantifies how many patient scheduled hours would result in a 40-h work week (PSH40) for ambulatory physicians and determines how PSH40 varies by specialty and practice type (Sinsky, 2024).
• This study characterizes the association of use of virtual scribes with changes in physicians' EHR time and identifies the physician, scribe, and scribe response factors associated with changes in EHR time upon virtual scribe use (Rotenstein, 2024).
• This study used national metadata to benchmark physician EHR time across specialties (Holmgren, 2024).
• This study explores the association between existing EHR efficiency tools and clinical resources on primary care physician (PCP) inbox time (Bundy, 2024).
• Precise, reliable, valid metrics that are cost-effective and require reasonable implementation time and effort are needed to drive EHR improvements and decrease EHR burden. This research group identified actionable solutions to address core categories of EHR metric implementation challenges (Levy, 2023 [PDF]).
• This longitudinal cohort study of ambulatory physicians at UCSF Health, a large academic medical center, finds a strong, linear relationship between telemedicine use and EHR time during and outside of patient scheduled hours – but not more messages received from patients (Holmgren, 2023).
• Primary care visits often start with a myriad of standardized intake screening questions that are tied to performance metrics and incorporated into EHRs. But prioritizing repetition of intake screening questionnaires at primary care visits may have unintended consequences such as administrative burden, provision of low-value care, and reduced clinical capacity to deliver other, high-value services (Simon, 2023).
• Perceived EHR stress and prescription reauthorization messages are significantly associated with burnout, as are non-EHR factors such as not feeling valued or aligned in values with clinic leaders. Younger physicians need more support. A multipronged approach targeting actionable levers and supporting young physicians is needed to implement sustainable improvements in physician well-being (Tai-Seale, 2023).
• Accurately quantifying clinician time spent on EHR activities outside the time scheduled with patients, formally known as work outside of work (WOW) is critical for understanding occupational stress associated with ambulatory clinic environments. Attributing all EHR work outside time scheduled with patients to WOW, regardless of when it occurs, will produce an objective and standardized measure better suited for use in efforts to reduce burnout, set policy, and facilitate research (Arndt, 2023).
• Physicians in outpatient ambulatory care receive more messages from patients through the EHR system than prior to the start of the COVID-19 pandemic. For physicians, the burden of managing an increasingly crowded inbox might be mitigated by having other members of the care team answer non-medical advice messages or reevaluating how that type of work is reimbursed (Nath, 2021).
• For every 8 hours of scheduled patient time, ambulatory physicians spend more than 5 hours in the EHR (Melnick, 2021).
• Analysis of patient messages, using Natural Language Processing, can facilitate identification of negative messages, including those with expletives and violent language, and inform subsequent interventions, such as automated inbox filters, root cause analysis of patient frustrations, and efforts to improve patient experience (Baxter, 2022).
• Vendor-derived audit-log data are useful; however, their limitations do not allow for derivation of all core EHR metrics and comparison of metrics across vendor products, demonstrating the value of measurement using other types of EHR use data (Melnick, 2021).
• Physicians using virtual scribe services experience improvements in their EHR documentation time and quality (Ong, 2021).
• Excess screenings, such as those for tobacco use, can result in unnecessary repetition and task-load, possibly contributing to unintended negative consequences in applying quality measures (Simon, 2021).
• Female physicians spend more time on the EHR overall, after-hours, and on EHR-based documentation than male physicians, suggesting that women physicians may benefit from policy changes, workflow improvements, and technologies that reduce documentation burden (Rotenstein, 2022).
• Volume of EHR use can be tracked and used to predict physician departure from practice (Melnick, 2021).
• There are strong associations between EHR usability and workload, meaning that improving EHR usability while decreasing task load may allow practicing physicians more working memory for medical decision making and patient communication (Melnick, 2022).

As EHR vendors adopt new and better data collection, and as health systems learn to maximize the potential of the available data, the measurement and utility of EHR use data will only get better. The AMA encourages continued research in this field to ensure that EHRs and other clinical technology are assets to medical practice and not a burden, and recognizes the importance of evidence-based improvements to one of the largest sources of dissatisfaction and contributors to burnout for practicing physicians.