EHR use & audit-log metadata

Andrew J Henreid, Kimon L H Ioannides +5

How do emergency physicians actually allocate shift time, and how much of it goes to the computer? This cross-sectional observational time-motion study in a high-volume urban ED used the validated TimeCaT application to track 20 physicians across one 8- to 9-hour shift each, totaling more than 150 hours of real-time observation, supplemented by EHR event logs for after-shift work. Physicians spent a median 34.1% of shift minutes on the computer (156.5 min) versus 26.9% with patients (115.2 min), plus 15.9% on verbal communication with staff. EHR logs showed an additional median 1.3 hours of post-shift computer use, or 29.8 combined computer minutes per scheduled hour. Visualizations showed frequent task switching and variable fragmentation.

Emma McCord, Nate C Apathy +5

What clinician characteristics moderate use of a chronic pain clinical decision support tool? Using electronic health record data from a pragmatic randomized controlled trial (October 2019–May 2022) covering 69 primary care clinicians with access to the OneSheet CDS, investigators modeled tool access within three days of an encounter, with generalized linear models testing clinician gender and years in practice as moderators. OneSheet was used in 959 of 145,511 encounters (0.7%). Use was lower for new-patient encounters (−0.42 percentage points; 95% CI −0.65 to −0.19) and higher for chronic pain diagnoses (3.48 pp) and long-term opioid therapy (4.70 pp). Associations were strongest among female clinicians with over 16 years in practice; prior use did not predict future use.

Viswanadham, R. V. N., Jones, S. A. +2

Does provider engagement with clinical decision support alerts vary by patient race and sex? This retrospective study used EHR data on alert-based CDS during outpatient primary care at a New York City academic health system, applying logistic regression to model alert engagement by patient race and sex with adjustment for encounter and provider factors, and a generalized structural equation model to test mediation by alert type. Direct effects indicated differential provider response by patient demographics; indirect effects indicated unequal assignment of alert types across groups, so uneven exposure alone could yield inequitable outcomes. The abstract reports no effect sizes.</summary