Doctors Check EHR Even on PTO

Primary care clinicians often log into electronic health records (EHR) even while on short vacations, according to findings from a retrospective cohort study published in JAMA Network Open. 

The researchers found that physicians spent a median of 16.1 minutes in the EHR per paid time off (PTO) day. Physicians also worked in EHRs on a median 39.0% of PTO days, with EHR use exceeding 30 minutes per day on a median 19.0% of PTO days. 

Working in the EHR during PTO off is associated with clinician burnout. In the workplace, burnout is associated with lower-quality patient care, decreased patient safety, and reduced patient satisfaction, among other issues. 

“While the actual amount of time spent in the EHR was not astoundingly high, we believe that even small amounts of EHR engagement could disrupt a physician’s ability to mentally disconnect from work,” said Corey Obermiller, MStat, a biostatistician in the Department of Internal Medicine at the Wake Forest University School of Medicine in Winston-Salem, North Carolina, who led the study. “Ideally, physicians should have the confidence to step away from work for a few days.”

Obermiller and his colleagues analyzed EHR use among 56 community and academic primary care physicians (PCPs) (33 men; 23 women; median age, 50.4 years) over a nearly 2-year period starting in January 2022.

To indicate vacation time, the researchers created blocks defined by two consecutive nonworking weekdays, along with any adjacent weekends.

On short vacations, defined as 2-5 days, physicians spent a median 50% of their PTO days engaging in some EHR use, whereas physicians on longer vacations spent a median 18% of their days with EHR use.

The researchers also found that physicians tended to use EHRs more frequently at the beginning (median, 57.0% of first days) and end (median, 63.5% of last days) of their vacations. Physicians spent a median of 39.5% of their EHR time in their inbox. No significant differences between academic and community PCPs in EHR use were observed.

The findings are not surprising, said Matthew Weissman, MD, MBA, a PCP and the chair of medicine at Maimonides Medical Center in Brooklyn, New York.

“I often show up in the morning to many messages that patients have sent overnight and have to go through them before I can really start my day,” Weissman said. “It’s sometimes hard to tell what’s urgent and what’s a more straightforward question.” 

Weissman said that checking EHR messages and other functions — even during PTO — can seem necessary.

“Primary care doctors want to be there for their patients,” he said. “Even when they’re on vacation, they don’t want to burden another overworked and likely burnt-out doctor with these tasks.” Obermiller noted physicians should prioritize clocking out fully.

“Ideally, regardless of personal thoughts and habits, all physicians should feel confident that they can fully step away from their work responsibilities without worrying about administrative or other work-related tasks piling up in their absence,” he said.

The research was supported by a grant from the American Medical Association.

One study author reported being an electronic health record consultant for the American Association of Medical Colleges CORE program, having an ownership interest in a product licensed to IllumiCare, and having other financial ties to private health companies. Two authors reported being employed by the American Medical Association.