Amid an uptick in publications looking to quantify the electronic health record (EHR) workload faced by clinicians, researchers propose three recommendations to ensure the accuracy and replicability of research in this space. Their recommendations include: 1) separating all time working in the EHR outside time scheduled with patients from time working in the EHR during time scheduled with patients, 2) including any time before or after scheduled appointments as "after-hours," and 3) encouraging the EHR vendor and research communities to develop validated methods for measuring active EHR use. Attributing all EHR work outside time scheduled with patients to Work Outside of Work (WOW), regardless of when it occurs, will produce an objective and standardized measure better suited for use in efforts to reduce burnout, set policy, and facilitate research.

The researchers argue that refining vendor-defined measures to better match the intention behind standardized "after-hours" EHR workload metrics, including WOW and WOW₈ (i.e. time spent in the EHR outside of time scheduled with patients, per eight hours scheduled with patients) will improve comparative research among health systems regardless of their EHR platforms.

What we know: Workload associated with electronic health record (EHR) documentation has contributed to increased rates of burnout among clinicians. This has been exacerbated by an increase in virtual care and the speed at which test results are released into patient portals, as well as increased portal messages. Understanding how to accurately quantify EHR workload is critical for understanding occupational stress associated with ambulatory clinic environments.

What this study adds: The authors argue that refining vendor-defined measures to better match the intention behind standardized "after-hours" EHR workload metrics will improve comparative research among health systems regardless of their EHR platforms and will illuminate how the work may be contributing to provider burnout.