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Appl Clin Inform 2023; 14(02): 309-320
DOI: 10.1055/a-2031-9437
Research Article

Effect of Telemedicine and the COVID-19 Pandemic on Medical Trainees' Usage of the Electronic Health Record in the Outpatient Setting

Kyle Mani‡   #
1   Department of Medicine, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, New York, United States
,
Jay Canarick‡   #
1   Department of Medicine, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, New York, United States
,
Elise Ruan
2   Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, United States
,
Jianyou Liu
3   Division of Biostatistics, Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, United States
,
Elizabeth Kitsis
2   Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, United States
,
Sunit P. Jariwala
4   Division of Allergy/Immunology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, United States
› Author Affiliations Funding This study did not receive any specific funding or sponsorship in the public, commercial, or nonprofit sectors for the design study; collection, analysis, review, or interpretation of data; or preparation of this manuscript.
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Abstract

Objectives This study aimed to (1) determine the impact of COVID-19 (coronavirus disease 2019) and the corresponding increase in use of telemedicine on volume, efficiency, and burden of electronic health record (EHR) usage by residents and fellows; and (2) to compare these metrics with those of attending physicians.

Methods We analyzed 11 metrics from Epic's Signal database of outpatient physician user logs for active residents/fellows at our institution across three 1-month time periods: August 2019 (prepandemic/pre-telehealth), May 2020 (mid-pandemic/post-telehealth implementation), and July 2020 (follow-up period) and compared these metrics between trainees and attending physicians. We also assessed how the metrics varied for medical trainees in primary care as compared with subspecialties.

Results Analysis of 141 residents/fellows and 495 attendings showed that after telehealth implementation, overall patient volume, Time in In Basket per day, Time outside of 7 a.m. to 7 p.m., and Time in notes decreased significantly compared with the pre-telehealth period. Female residents, fellows, and attendings had a lower same day note closure rate before and during the post-telehealth implementation period and spent greater time working outside of 7 a.m. to 7 p.m. compared with male residents, fellows, and attendings (p < 0.01) compared with the pre-telehealth period. Attending physicians had a greater patient volume, spent more time, and were more efficient in the EHR compared with trainees (p < 0.01) in both the post-telehealth and follow-up periods as compared with the pre-telehealth period.

Conclusion The dramatic change in clinical operations during the pandemic serves as an inflection point to study changes in physician practice patterns in the EHR. We observed that (1) female physicians closed fewer notes the same day and spent more time in the EHR outside of normal working hours compared with male physicians, and (2) attending physicians had higher patient volumes and also higher efficiency in the EHR compared with resident physicians.

Keywords

EHR usage - telemedicine - COVID-19 - residents - fellows - attendings - physician health

Protection of Human and Animal Subjects

This study complied with the World Medical Association Declaration of Helsinki on Ethical Principles for Medical Research Involving Human Subjects and was approved by the Albert Einstein Institutional Review Board. No human subjects were involved in this project.


# These authors contributed equally to the manuscript.




Publication History

Received: 29 July 2022

Accepted: 06 February 2023

Accepted Manuscript online:
09 February 2023

Article published online:
26 April 2023

© 2023. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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