Association between state-level malpractice environment and clinician electronic health record (EHR) time. Journal of the American Medical Informatics Association : JAMIA Holmgren, A. J., Rotenstein, L., Downing, N. L., Bates, D. W., Schulman, K. 2022


OBJECTIVE: 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.MATERIALS AND METHODS: 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.RESULTS: 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).DISCUSSION: State-level differences in malpractice incidence are unlikely to be a significant driver of EHR work for most clinicians.CONCLUSION: 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.

View details for DOI 10.1093/jamia/ocac034

View details for PubMedID 35271723