Female clinicians spend more 'pajama time' documenting in the EHR

New research from electronic health record vendor athenahealth finds that gender, specialty and geography are among the top factors that contribute to time spent charting in the EHR after hours.  

Specifically, athenahealth pointed to women; gastroenterologists and orthopedic surgeons; and clinicians in the Northeast as spending more of what the vendor calls "pajama time" in the EHR.  

"Many clinicians believe that risk-based models embracing quality over volume may allow them to spend more time with patients and focus on who needs help rather than on a clock," wrote Carley Thornell, senior thought leadership writer at athenahealth, in a blog post about the research.

"But getting there will require organizational support systems, and standardization of quality targets and terminology," she said.  


Other studies have shown that after-hours workload is a major contributing factor to burnout, which has sharply increased amid the global COVID-19 pandemic.   

For this research, the athenahealth team used deidentified data from across its network of customers to examine time spent in the EHR – both during and outside of patient encounters – in the first half of 2021.  

They found that a healthcare organization’s size and its culture can each contribute to time spent in the EHR relative to each patient.  

For instance, organizations that require more complex documentation – which also tend to be larger, meaning in this case having 22 or more clinicians – often employ providers who spend more time in the EHR.  

Meanwhile, clinicians who control their own schedules – who generally work at smaller practices – report having less pajama time in the EHR.   

"But that can also come at costs both figurative and literal," noted Thornell.  

The researchers also narrowed in on specialties, noting that adult-medicine primary care clinicians and neurologists spend the most time total in the EHR. Meanwhile, mental health clinicians both see the fewest patients and spend the lowest percentage of their EHR time outside of patient appointment hours.  

And gender also played a role.  

The team found that female and male clinicians spend the same amount of hours, on average, in the EHR. But women spend more time on the EHR per patient, and more time in the record after hours.

Some of the differences are striking: Female cardiology clinicians' documentation time per encounter is 62% higher than their male counterparts.  

"These findings represent another example of how the traditional, volume-based payment model for physician services contributes to gender inequities in healthcare," said Jessica Sweeney-Platt, vice president of research and editorial strategy at athenahealth, in a statement.   

"Female clinicians tend to spend more time with patients, which we’ve learned includes the amount of time they spend in capturing and documenting each patient’s story," she added.  


Other studies have sought to draw links between demographic identifiers and time spent in the EHR. 

For instance, a research letter published in December 2020 found that female physicians tend to spend more time on all EHR metrics than their male counterparts.

Perhaps relatedly, women were also reporting the highest levels of burnout in January 2021.  


Value-based care models could change incentives around visit volume and reward clinicians for spending more time per patient, including capturing the full story of each patient," Sweeney-Platt suggested. "Over time, this shift in focus could have a big impact in alleviating burnout."

Kat Jercich is senior editor of Healthcare IT News.
Twitter: @kjercich
Email: [email protected]
Healthcare IT News is a HIMSS Media publication.

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