ArticleJournal of general internal medicine2023
Physician Note Composition Patterns and Time on the EHR Across Specialty Types: a National, Cross-sectional Study.
Article in Journal of general internal medicine, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 16 papers, 1 of them a synthesis that pooled it.
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Who cites it
16 citing papers in PubMed, 1 synthesis or guideline pooled it, 22 citations in OpenAlex.
- Measuring Documentation Burden in Healthcare.Journal of general internal medicine · 2024Pooled it
- AI-Assisted Clinical Documentation in Routine Danish General Practice: Quantitative Pre-Post Study.JMIR human factors · 2026Article
- The Growing Use of Copy-Paste and Its Impact on Creation and Propagation of Documentation Errors.CHEST pulmonary · 2026Article
- Clinical Context Variables Collectively Rival Model Choice in Embedding-Based Retrieval: Multi-Corpus Benchmark Study.JMIR medical informatics · 2026Article
- Electronic health record use factors linked to efficiency and productivity: an explainable machine learning analysis.JAMIA open · 2026Article
- Nested order panels for adult primary care modestly improves ordering efficiency among high utilizers.JAMIA open · 2026Article
- Copy Tools in the Electronic Health Record: Perceptions, Implications, and Future Directions.JMIR medical informatics · 2025Article
- Behavioral Phenotypes in Electronic Health Record Use by Primary Care Providers: a Cluster Analysis.Journal of general internal medicine · 2025Article
- Exploring Provider Perceptions and Attitudes toward Copy-Paste and Copy-Forward in Clinical Documentation.Applied clinical informatics · 2025Article
- Does autotext usage decrease documentation time among resident physicians? A retrospective analysis of electronic health record usage data.JAMIA open · 2025Article
- Analyzing Physician In Basket Burden and Efficiency Using K-Means Clustering.Applied clinical informatics · 2025Article
- Evaluation of an Ambient Artificial Intelligence Documentation Platform for Clinicians.JAMA network open · 2025Article
- Describing atopic dermatitis in real-world clinical practice: a retrospective health system analysis.Archives of dermatological research · 2025Article
- Article
- Consistency is key: documentation distribution and efficiency in primary care.Journal of the American Medical Informatics Association : JAMIA · 2024Article
- Electronic Health Record Usability, Satisfaction, and Burnout for Family Physicians.JAMA network open · 2024Article
Corrections and comments
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Authors and funding
4 authors at 2 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundThe burden of clinical documentation in electronic health records (EHRs) has been associated with physician burnout. Numerous tools (e.g., note templates and dictation services) exist to ease documentation burden, but little evidence exists regarding how physicians use these tools in combination and the degree to which these strategies correlate with reduced time spent on documentation.
objectiveTo characterize EHR note composition strategies, how these strategies differ in time spent on notes and the EHR, and their distribution across specialty types.
designSecondary analysis of physician-level measures of note composition and EHR use derived from Epic Systems' Signal data warehouse. We used k-means clustering to identify documentation strategies, and ordinary least squares regression to analyze the relationship between documentation strategies and physician time spent in the EHR, on notes, and outside scheduled hours.
participantsA total of 215,207 US-based ambulatory physicians using the Epic EHR between September 2020 and May 2021. MAIN MEASURES: Percent of note text derived from each of five documentation tools: SmartTools, copy/paste, manual text, NoteWriter, and voice recognition and transcription; average total and after-hours EHR time per visit; average time on notes per visit. KEY
resultsSix distinct note composition strategies emerged in cluster analyses. The most common strategy was predominant SmartTools use (n=89,718). In adjusted analyses, physicians using primarily transcription and dictation (n=15,928) spent less time on notes than physicians with predominant Smart Tool use. (b=-1.30, 95% CI=-1.62, -0.99, p<0.001; average 4.8 min per visit), while those using mostly copy/paste (n=23,426) spent more time on notes (b=2.38, 95% CI=1.92, 2.84, p<0.001; average 13.1 min per visit).
conclusionsPhysicians' note composition strategies have implications for both time in notes and after-hours EHR use, suggesting that how physicians use EHR-based documentation tools can be a key lever for institutions investing in EHR tools and training to reduce documentation time and alleviate EHR-associated burden.
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