After-hours electronic health record use among ophthalmology residents

Abstract

Purpose : Electronic health record (EHR) access logs provide granular data on how users interact with EHRs and can be used to understand resident workflows. Residents are at high risk of burnout; national policies regarding resident work hours are continually evolving. However, the workload of ophthalmology residents is not well-described. The purpose of this study was to use EHR access logs to characterize after-hours activities of ophthalmology residents while on call.

Methods : EHR access logs for all ophthalmology residents at a single program taking primary call (n=12) over a 12-month period were obtained. Logs were compared with resident call schedules to analyze data based on call shifts (weekday evenings, weekday overnights, weekends, and holidays). Total time spent logged in and the number of unique patient charts accessed per shift were calculated for each shift type. Finally, EHR tasks performed after-hours were described based on activity metrics.

Results : The median (IQR) number of minutes ophthalmology residents were logged in to the EHR while on call ranged from 38 (57.8) on weekday overnights to 201 (213.5) on 24-hr weekend calls (Table 1). Median (IQR) unique patient charts accessed ranged from 4.0 (3.0) on weekday overnights to 17.0 (10.5) on holidays (Table 1). Time logged in decreased during the spring months but increased in the summer months (July-September, Fig. 1A). Number of patients accessed also increased in the summer (Fig. 1B). Conditions seen on call were tabulated using patients’ diagnosis codes. The top 3 diagnoses were screening for eye condition (285/6910, 4.1%), post-operative state (271/6910, 3.9%), and dermatochalasis (110/6910, 1.6%). The most common activities in the EHR were viewing notes (10.4%) and viewing reports with patient data (10.1%).

Conclusions : EHR access logs can not only be used to characterize ophthalmology residents’ on-call activities but also to understand educational experiences and approximate workload. These results can inform efforts to address physician well-being and burnout, both locally through curriculum design and rotation scheduling as well as nationally through duty hour policy.

This is a 2020 ARVO Annual Meeting abstract.

 

Table 1. Time and clinical volume of after-hours EHR use for ophthalmology residents for various call shifts over 1-year.

 

Figure 1. Longitudinal view of (A) time spent logged into the EHR per call shift and (B) number of unique patient charts accessed per call shift (Oct 2018-Sept 2019).