ArticleJournal of the American Medical Informatics Association : JAMIA2022
Association between state-level malpractice environment and clinician electronic health record (EHR) time.
Article in Journal of the American Medical Informatics Association : JAMIA, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 5 papers, 1 of them a synthesis that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
5 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Measuring Documentation Burden in Healthcare.Journal of general internal medicine · 2024Pooled it
- Use of Ambient AI Scribes to Reduce Administrative Burden and Professional Burnout.JAMA network open · 2025Article
- Use of Epic Electronic Health Record System for Health Care Research: Scoping Review.Journal of medical Internet research · 2023Article
- Documentation dynamics: Note composition, burden, and physician efficiency.Health services research · 2023Article
- Assessing the impact of patient access to clinical notes on clinician EHR documentation.Journal of the American Medical Informatics Association : JAMIA · 2022Article
Corrections and comments
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Authors and funding
5 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectiveClinicians 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
methodsWe 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.
resultsWe 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.
conclusionPolicymakers seeking to address EHR documentation burden should examine burden driven by other socio-technical demands on clinician time, such as billing or quality measurement.
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