Gender gap in EHR use among PCPs continues to grow, study finds
Female primary care physicians spend more time using electronic health records than male PCPs, and this gap has widened over time, according to a study published in the Journal of General Internal Medicine.
“The gender gap in EHR use is growing, particularly for note writing, inbox management, and time outside scheduled clinical hours,” Adam Rule, PhD, an assistant professor at the University of Madison-Wisconsin Information School, and colleagues wrote.
To assess trends in electronic health record (EHR) usage among PCPs, “who use EHRs more than physicians in other specialties,” the researchers collected monthly data from April 2019 to March 2022 from Epic Systems, a private health care software company.
Rule and colleague used five measures to determine gaps in EHR usage: total EHR time, time in notes, time in orders, time in inbox and time outside scheduled clinic hours. These metrics were analyzed through both model-adjusted and unadjusted comparisons.
The analysis included responses from 160 PCPs, 108 of whom were women. All the participants practiced at the University of Wisconsin Health academic medical center during the study period.
From April 2021 to March 2022, the researchers found that female physicians averaged an unadjusted mean total of 7 hours in total EHR time, compared with 5.3 mean hours for male physicians (P < .001).
Female physicians also spent more time in notes (2.5 vs. 1.4 hours; P < .001), time in inbox (1.3 vs. 1 hours; P = .001) and time outside scheduled clinic hours (3.1 vs. 2 hours; P < .001) compared with their male counterparts.
In adjusted comparisons, female physicians had higher means of:
- total EHR time (1.5 hours; 95% CI, 0.7-2.4);
- total time in notes (0.9 hours; 95% CI, 0.5-1.4);
- total time in inbox (0.2 hours; 95% CI, 0.1-0.4); and
- total time outside schedule clinic hours (1.1 hours; 95% CI, 0.4-1.8).
The only measure that women did not significantly spend more time doing in adjusted and unadjusted analyses was time in orders, according to the researchers.
When examining the change in EHR usage over time, Rule and colleagues reported that from 2019 to 2021, the gap increased by:
- 8.3 minutes a year for total EHR time (95% CI, 4.6-11.9);
- 6.1 minutes a year for time in notes (95% CI, 4.1-8);
- 3.3 minutes a year for time in inbox (95% CI, 2.2-4.4); and
- 6.6 minutes a year for time outside scheduled clinic hours (95% CI, 2.7-9.6).
The researchers noted that the disparities in EHR use are larger than those reported in previous studies, a development which “may be due to differences in health systems, time periods, or specialties observed,” they wrote.
Rule and colleagues also expressed concern over the gap in time outside scheduled clinic hours given the links between burnout and outside-hours EHR usage. A 2017 study in the Journal of Graduate Medical Education found that 75% of PCPs attributed burnout to EHR time, and those who spent more than 6 hours weekly in EHR time were 2.9 times more likely to report burnout.
“It is critical that health systems explore root causes behind these differences and develop solutions to address them considering the higher burnout among female physicians,” Rule and colleagues wrote.
The researchers proposed several potential solutions, including additional documentation and inbox support, reduced patient contact and a reduced panel size. They concluded that future research should further examine EHR gender gaps in other domains “and the impact of targeted interventions to reduce EHR burden for female physicians.”
References:
- Robertson S, et al. J Grad Med Educ. 2017;doi:10.4300/JGME-D-16-00123.1.
- Rule A, et al. J Gen Intern Med. 2022;doi:10.1007/s11606-022-07837-2.