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- Title
Association between state-level malpractice environment and clinician electronic health record (EHR) time.
- Authors
Holmgren, A Jay; Rotenstein, Lisa; Downing, Norman Lance; Bates, David W; Schulman, Kevin
- Abstract
<bold>Objective: </bold>Clinicians spend significant time working in the electronic health record (EHR). The US is an outlier in EHR time, suggesting that EHR-related work may be driven in part by the legal environment and threat of malpractice. To assess this, we evaluate the association between state-level malpractice climate and clinician time spent in the EHR.<bold>Materials and Methods: </bold>We use EHR metadata from 351 ambulatory care health systems in the United States using Epic from January-August 2019 combined with state-level data on malpractice incidence and payouts. We used descriptive statistics to measure variation in clinician EHR time, including total EHR time, documentation time per day, and after-hours EHR time per day. Multi-variable regression evaluated the association between clinicians in high malpractice states and EHR use.<bold>Results: </bold>We found no association between location in a state in the top-quartile of malpractice payouts and time spent in the EHR per day, time spent in the EHR outside of scheduled hours, or time spent documenting per day, except for a subgroup of the clinicians in the highest malpractice specialties, where there was a small increase in EHR time per day (B = 6.08 min, P < 0.001) and time spent documenting notes (B = 2.77 min, P < 0.001).<bold>Discussion: </bold>State-level differences in malpractice incidence are unlikely to be a significant driver of EHR work for most clinicians.<bold>Conclusion: </bold>Policymakers seeking to address EHR documentation burden should examine burden driven by other socio-technical demands on clinician time, such as billing or quality measurement.
- Subjects
UNITED States; ELECTRONIC health records; METADATA; MALPRACTICE; MEDICAL personnel; OUTPATIENT medical care
- Publication
Journal of the American Medical Informatics Association, 2022, Vol 29, Issue 6, p1069
- ISSN
1067-5027
- Publication type
journal article
- DOI
10.1093/jamia/ocac034