Not all EHR use measures are created equally, study finds

A paper published this month in the Journal of the American Medical Informatics Association found that vendors vary in their development maturity of outpatient EHR use measures.

Although Epic, Cerner and Allscripts have developed EHR use measures in client-available platforms, researchers found that athenahealth’s are still in development, and eClinicalWorks and NextGen have no existing EHR use measures.

Furthermore, the researchers found that the vendor-provided EHR use measures often differ from previously proposed measures of EHR use.


Without standardized measures of EHR use across vendors and systems, it will remain difficult to study the impact of EHRs on burnout, the researchers contend.

Earlier this year, a team that included representatives from the American Medical Association, Oregon Health Sciences University, Mathematica, the University of Wisconsin and others published proposed EHR use measures using log data. 

In addition to the general availability of use measures, researchers from the latest study compared the vendor-provided EHR use measures with those proposed use measures – and found some marked differences.

For example, while Cerner and Epic do measure “total EHR time” during an outside of clinic sessions, that measurement is not normalized to eight hours of scheduled patient time, as has been proposed. Rather, it’s normalized to per patient or per day.

Similarly, the definition of “work outside of work” varies considerably. According to researchers, vendors measure inbox-related work strictly in the inbox, whereas proposed measures would also include time on “immediate actions related to inbox messages.”

“Resolving inbox messages often requires work in areas of the EHR other than the inbox, and may even involve tasks that are not reflected in EHR log data at all (e.g., phone calls to consulting providers or to patients). 

“The proposed measure would include these actions, although best practices regarding how to define actions related to inbox messages are still evolving,” noted the researchers.

The study notes that it is difficult, in general, to develop standardized EHR use measures – but that “time on the clock” and clinical volume are important domains for doing so.

“Over the long term, standardization will not only require consensus on appropriate measure definitions, but also interorganizational collaboration and ongoing maintenance,” researchers wrote.

“Understanding vendors’ development of these measures can help inform the ongoing process of developing standardized measures,” they said.


The role EHRs play in clinician burnout is well-documented, although the specific root causes – and the strategies for addressing them – vary. 

Some systems have pointed to clinician engagement as one way forward, reasoning that if users are invested in their technology, they’re more likely to be satisfied with it.

“We engage [physicians] and give them the opportunity to build and make something, and it tends to make them committed,” said OrthoVirginia Chief Medical Information Officer Dr. Harry C. Eschenroeder Jr. during a HIMSS20 Digital presentation this year.


“The initiatives of vendors to develop these measures and engage in conversations about standardization, even without top-down regulatory requirements, is encouraging,” wrote the researchers. “Understanding variations and working toward standardization will facilitate future work to compare studies across diverse organizations in the effort to measure and improve physician burnout.”


Kat Jercich is senior editor of Healthcare IT News.
Twitter: @kjercich
Email: [email protected]
Healthcare IT News is a HIMSS Media publication.

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