ArticleAnnals of family medicine
More Tethered to the EHR: EHR Workload Trends Among Academic Primary Care Physicians, 2019-2023.
Article in Annals of family medicine. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 41 papers, 2 of them syntheses that pooled it.
What it found
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The trial behind it
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
41 citing papers in PubMed, 2 syntheses or guidelines pooled it.
- Family physician perspectives on managing indirect patient care activities in the electronic inbox: a systematic mixed studies review.Family practice · 2025Pooled it
- Measuring Documentation Burden in Healthcare.Journal of general internal medicine · 2024Pooled it
- Periodontitis Risk Assessment and Prevention Planning: Comparative Study of Multimodal Large Language Models and Periodontist Evaluations.Journal of medical Internet research · 2026Article
- Ontario family physician perspectives on whether and how to charge patients for uninsured services: Qualitative study.Canadian family physician Medecin de famille canadien · 2026Article
- Beyond Transparency : Ethical Note Obligations, Documentation Burden, and the Ethical Adoption of AI-Assisted Documentation.Journal of bioethical inquiry · 2026Article
- A Structural and Educational Intervention to Improve Inter-Visit Care in an Internal Medicine Residency Clinic: A Multimethod Evaluation.Journal of general internal medicine · 2026Article
- The Inbox Problem: Standardized Protocols for Primary Care Teams to Address Patient Messages.Journal of general internal medicine · 2026Article
- Examining patient-centered vs. doctor-centered attitudes among Austrian general practitioners : A cross-sectional study on time constraints and care orientation.Wiener klinische Wochenschrift · 2026Article
- Real-Time Expert Support for Addiction Care Across General Medical Settings: Evaluation of a Chat-Based Intervention.Substance use & addiction journal · 2026Article
- Detecting Uncoded Self-Harm in Veterans' Electronic Health Records Using Positive and Unlabeled Learning: Retrospective Cohort Study.Journal of medical Internet research · 2026Article
- More Indirect Patient Care Activities per Visit: 11-Year Analysis of Family Physician Electronic Health Records in Canada.Annals of family medicine · 2026Article
- A scoping review of studies on secure messaging through patient portals: persistent challenges and potential solutions.npj health systems · 2026Article
- After-Hours Use of the Electronic Health Record Among Medical and Surgical Specialists After Implementation of a System-Wide Integrated Clinical Information System in Alberta, Canada: Longitudinal Descriptive Study.Journal of medical Internet research · 2026Article
- Review
- Variation in Measures of Electronic Health Record Use Outside Scheduled Hours: A Cross-Sectional Study of Academic Primary Care Physicians.Applied clinical informatics · 2026Article
- Providing Beyond Clinic Hours: A Single-center Analysis of Patient Portal Communication in Pediatric Orthopaedic Care.Journal of the Pediatric Orthopaedic Society of North America · 2026Article
- Performance of an Intelligent Messaging Tool for Clinical Communications.JAMA network open · 2026Article
- Work outside of work: after-hours use of the electronic medical record among residents at an academic veterinary teaching hospital.Frontiers in veterinary science · 2026Article
- Growth In Number Of Practices And Clinicians Participating In Concierge And Direct Primary Care, 2018-23.Health affairs (Project Hope) · 2025Article
- Insulin Rationing Persists Despite Policy Changes: Repeated Cross-Sectional Studies, 2017 vs 2024.Journal of general internal medicine · 2025Article
Corrections and comments
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Authors and funding
6 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
purposeThe purpose of this study is to evaluate recent trends in primary care physician (PCP) electronic health record (EHR) workload.
methodsThis longitudinal study observed the EHR use of 141 academic PCPs over 4 years (May 2019 to March 2023). Ambulatory full-time equivalency (aFTE), visit volume, and panel size were evaluated. Electronic health record time and inbox message volume were measured per 8 hours of scheduled clinic appointments.
resultsFrom the pre-COVID-19 pandemic year (May 2019 to February 2020) to the most recent study year (April 2022 to March 2023), the average time PCPs spent in the EHR per 8 hours of scheduled clinic appointments increased (+28.4 minutes, 7.8%), as did time in orders (+23.1 minutes, 58.9%), inbox (+14.0 minutes, 24.4%), chart review (+7.2 minutes, 13.0%), notes (+2.9 minutes, 2.3%), outside scheduled hours on days with scheduled appointments (+6.4 minutes, 8.2%), and on unscheduled days (+13.6 minutes, 19.9%). Primary care physicians received more patient medical advice requests (+5.4 messages, 55.5%) and prescription messages (+2.3, 19.5%) per 8 hours of scheduled clinic appointments, but fewer patient calls (-2.8, -10.5%) and results messages (-0.3, -2.7%). While total time in the EHR continued to increase in the final study year (+7.7 minutes, 2.0%), inbox time decreased slightly from the year prior (-2.2 minutes, -3.0%). Primary care physicians' average aFTE decreased 5.2% from 0.66 to 0.63 over 4 years.
conclusionsPrimary care physicians' time in the EHR continues to grow. While PCPs' inbox time may be stabilizing, it is still substantially higher than pre-pandemic levels. It is imperative health systems develop strategies to change the EHR workload trajectory to minimize PCPs' occupational stress and mitigate unnecessary reductions in effective physician workforce resulting from the increased EHR burden.
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