EHR audit logs: A new goldmine for health services research?

Adler‐Milstein, Julia; Adelman, Jason S.; Tai-Seale, Ming; Patel, Vimla L.; Dymek, Chris

doi:10.1016/j.jbi.2019.103343

Cited by 78 publications

(60 citation statements)

References 23 publications

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“…7,8 While the auditlog data were originally designed to support auditing of inappropriate record access, it provides an opportunity to study clinical activities unobtrusively and at scale. [7][8][9] Time spent in the EHR, specifically, has been identified as an important unit of measure of health care provider clinical activity as it is a commodity in limited supply for health care professionals and has been implicated as a risk factor for health care provider burnout. 7,[9][10][11] Audit-log data have shown promise in measuring time spent on ambulatory clinical activities, [12][13][14][15][16] but it is not known if EHR times derived from raw audit-log data will reliably correspond to inpatient clinical inactivity given differences in EHR use patterns between inpatient and ambulatory providers.…”

Section: Background and Significancementioning

confidence: 99%

Measuring Electronic Health Record Use in the Pediatric ICU Using Audit-Logs and Screen Recordings

Sinha

Stevens

et al. 2021

Appl Clin Inform

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Background Time spent in the electronic health record (EHR) has been identified as an important unit of measure for health care provider clinical activity. The lack of validation of audit-log based inpatient EHR time may have resulted in underuse of this data in studies focusing on inpatient patient outcomes, provider efficiency, provider satisfaction, etc. This has also led to a dearth of clinically relevant EHR usage metrics consistent with inpatient provider clinical activity. Objective The aim of our study was to validate audit-log based EHR times using observed EHR-times extracted from screen recordings of EHR usage in the inpatient setting. Methods This study was conducted in a 36-bed pediatric intensive care unit (PICU) at Lucile Packard Children's Hospital Stanford between June 11 and July 14, 2020. Attending physicians, fellow physicians, hospitalists, and advanced practice providers with ≥0.5 full-time equivalent (FTE) for the prior four consecutive weeks and at least one EHR session recording were included in the study. Citrix session recording player was used to retrospectively review EHR session recordings that were captured as the provider interacted with the EHR. Results EHR use patterns varied by provider type. Audit-log based total EHR time correlated strongly with both observed total EHR time (r = 0.98, p < 0.001) and observed active EHR time (r = 0.95, p < 0.001). Each minute of audit-log based total EHR time corresponded to 0.95 (0.87–1.02) minutes of observed total EHR time and 0.75 (0.67–0.83) minutes of observed active EHR time. Results were similar when stratified by provider role. Conclusion Our study found inpatient audit-log based EHR time to correlate strongly with observed EHR time among pediatric critical care providers. These findings support the use of audit-log based EHR-time as a surrogate measure for inpatient provider EHR use, providing an opportunity for researchers and other stakeholders to leverage EHR audit-log data in measuring clinical activity and tracking outcomes of workflow improvement efforts longitudinally and across provider groups.

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Section: Background and Significancementioning

confidence: 99%

Measuring Electronic Health Record Use in the Pediatric ICU Using Audit-Logs and Screen Recordings

Sinha

Stevens

et al. 2021

Appl Clin Inform

View full text Add to dashboard Cite

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“…Research relying on audit logs [70][71][72][73] or similar passive measurements to complement results of self-report measures can potentially be used to ascertain the true changes in EHR use during the pandemic. Future studies should also look at longitudinal relationships between EHR use, COVID-19 patient exposure, and mental health distress.…”

Section: Conclusion and Future Researchmentioning

confidence: 99%

Impact of Changes in EHR Use during COVID-19 on Physician Trainee Mental Health

et al. 2021

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Objectives This article investigates the association between changes in electronic health record (EHR) use during the coronavirus disease 2019 (COVID-19) pandemic on the rate of burnout, stress, posttraumatic stress disorder (PTSD), depression, and anxiety among physician trainees (residents and fellows). Methods A total of 222 (of 1,375, 16.2%) physician trainees from an academic medical center responded to a Web-based survey. We compared the physician trainees who reported that their EHR use increased versus those whose EHR use stayed the same or decreased on outcomes related to depression, anxiety, stress, PTSD, and burnout using univariable and multivariable models. We examined whether self-reported exposure to COVID-19 patients moderated these relationships. Results Physician trainees who reported increased use of EHR had higher burnout (adjusted mean, 1.48 [95% confidence interval [CI] 1.24, 1.71] vs. 1.05 [95% CI 0.93, 1.17]; p = 0.001) and were more likely to exhibit symptoms of PTSD (adjusted mean = 15.09 [95% CI 9.12, 21.05] vs. 9.36 [95% CI 7.38, 11.28]; p = 0.035). Physician trainees reporting increased EHR use outside of work were more likely to experience depression (adjusted mean, 8.37 [95% CI 5.68, 11.05] vs. 5.50 [95% CI 4.28, 6.72]; p = 0.035). Among physician trainees with increased EHR use, those exposed to COVID-19 patients had significantly higher burnout (2.04, p < 0.001) and depression scores (14.13, p = 0.003). Conclusion Increased EHR use was associated with higher burnout, depression, and PTSD outcomes among physician trainees. Although preliminary, these findings have implications for creating systemic changes to manage the wellness and well-being of trainees.

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“…Various studies, including our prior research, have leveraged health-care worker activities in EHR systems to infer patterns of collaboration [9,10,[14][15][16][17][18][19]. The proportion of care activities performed via EHR systems has steadily increased with the adoption of EHR through meaningful use of incentives [22,26].…”

Section: Ehr System Utilization Datamentioning

confidence: 99%

Learning Health-Care Worker Networks from Electronic Health Record Utilization

Chen¹

2021

Teamwork in Healthcare

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The health-care system is a highly collaborative environment where health-care workers collaborate to care for patients. Health-care organizations (HCOs) design and develop various types of staffing plans to promote collaboration among healthcare workers. The existing staffing plans describe the cooperation at a coarsegrained level, such as team scheduling. They seldom consider connections among health-care workers and investigate how health-care workers receive and disseminate information, which is essential evidence to inform actionable staffing interventions to improve care quality and patient safety. In this chapter, we introduce how to apply network analysis methods to electronic health record (EHR) utilization data to learn connections among health-care workers and build networks to describe teamwork in a fine-grained level. The chapter includes: (i) a brief description of the EHR utilization data, (ii) approaches to learn connections among health-care workers, (iii) building health-care worker networks, (iv) developing survey instruments to validate health-care worker networks, (v) introducing sociometric measurements to quantify network structures and positions of health-care workers in the networks, (vi) using statistical models to test associations between teamwork structures and patient outcomes, and (vii) listing examples to learn health-care worker networks in an HCO and a specific setting, including neonatal intensive care unit and trauma.

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EHR audit logs: A new goldmine for health services research?

Cited by 78 publications

References 23 publications

Measuring Electronic Health Record Use in the Pediatric ICU Using Audit-Logs and Screen Recordings

Measuring Electronic Health Record Use in the Pediatric ICU Using Audit-Logs and Screen Recordings

Impact of Changes in EHR Use during COVID-19 on Physician Trainee Mental Health

Learning Health-Care Worker Networks from Electronic Health Record Utilization

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