Properly measuring use of the EHR is essential for health care IT and clinical leaders to see how physicians’ and other health professionals’ time is being spent, identify areas that can be improved, and measure success at improvement.

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That is the key takeaway from a perspective piece co-written earlier this year by the AMA’s vice president of professional satisfaction, internist Christine A. Sinsky, MD. She and the co-authors of “Metrics for assessing physician activity using electronic health record log data,” published in the Journal of the American Medical Informatics Association, called for standardizing EHR log data measure specifications and normalizing the time measures to eight hours of patient scheduled time.

The seven core measures of EHR use that reflect the many dimensions of practice efficiency are:

  • Total EHR time. Total time a physician spends on EHR during and outside of clinic sessions.
  • Work done outside of work. Time spent on EHR outside of scheduled patient hours per eight hours of patient scheduled time.
  • Time on documentation. Hours on documentation—note writing—per eight hours of scheduled patient time.
  • Time on prescriptions. Total time on prescriptions per eight hours of patient scheduled time.
  • Inbox time. Total time spent dealing with an inbox per eight hours of patient scheduled time.
  • Teamwork for orders. The percentage of orders that have team contribution.
  • Undivided attention. The amount of undivided attention physicians give patients, which is approximated by looking at the total time during a session and subtracting how much time is spent using the EHR during that time, then diving that number by the total time of the session.

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Standardizing EHR log data measure specifications and time measures will result in better reproducibility and comparison of research studies, the perspectives says.

“It is our intent that the measures provide in-sight and facilitate research regarding the efficiency of using EHRs in the practice environment, the effectiveness of teams, the impact of policies and regulations, and practice characteristics that contribute to physician distress or well-being,” Dr. Sinsky and her colleagues wrote in the piece, published prior to the onset of the COVID-19 pandemic in the spring. “Improving the physician experience should, in turn, positively impact the patient experience as well.”

Visit the AMA digital health page to learn more about how the AMA is committed to ensuring the physician perspective is represented in the design, implementation and evaluation of new health care technologies.

Practical applications

EHR use measures have multiple uses within research and clinic administration, study authors note.

For example, they can be used to assess the impact of new staffing models, such as advanced team- based care with in-room support.

In environments where physicians practice in advanced team-based models of care, they may be able to spend most of their time giving patients undivided attention while staff members enter orders, complete billing invoices, draft preliminary visit notes and manage team inbox.

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For a physician, practicing in a “doctor-does-it-all” environment where he or she performs the majority of data entry and inbox management, EHR use measures can help quantify the difference by establishing the degree to which the time they spend on EHR and note documentation outside of the eight hours of scheduled patient time decreases and the percentage of orders that have team contribution increases and when the practice moves to an advanced team-based model of care.

“While we expect EHR use measures will need to adapt over time in response to advances in technology, changing clinician roles, and evolving regulatory policies, these measures provide a starting point to enhance consistency and reproducibility for analyses of current systems,” says the perspective essay.

The AMA collaborated with MedStar Health to create EHRSeeWhatWeMean.org to demonstrate the risks and challenges caused by poor usability in electronic health record technology that reduce time available for physicians to care for patients.

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