Does Physician’s Choice of When to Perform EHR Tasks Influence Total EHR Workload?

Problem definition: Physicians spend more than 5 hours a day working on Electronic Health Record (EHR) systems and more than an hour doing EHR tasks after the end of the workday. Numerous studies have identified the detrimental effects of excessive EHR use and after-hours work, including physician burnout, physician attrition, and appointment delays. However, EHR time is not purely an exogenous factor as it depends on physician usage behavior that could have important operational consequences.Interestingly, prior literature has not considered this topic rigorously. In this paper, we investigate howphysicians' workflow decisions on when to perform EHR tasks affect: (1) total time on EHR and (2) timespent after work.Methodology/Results: Our data comprise around 150,000 appointments from 74 physicians from a largeAcademic Medical Center Family Medicine unit. Our dataset contains detailed, process-level time stampsof appointment progression and EHR use. We find that the effect of working on EHR systems depends onwhether the work is done before or after an appointment. Pre-appointment EHR work reduces total EHRworkload and after-work hours spent on EHR. Post-appointment EHR work reduces after-work hours onEHR but increases total EHR time. We find that increasing idle time between appointments can encourageboth pre- and post-appointment EHR work.Managerial implications: Our results not only help us understand the timing and structure of work onsecondary tasks, more generally, but also will help healthcare administrators create EHR workflows andappointment schedules to reduce physician burnout associated with excessive EHR use.