U.S. clinicians spend 50% more time in EHR than those in other countries

A pair of studies recently published in the Journal of the American Medical Association and Medical Care aims to use electronic health record data to analyze how clinicians spend their time.  

The JAMA study, which compared metadata of clinicians in the United States with those in Canada, Northern Europe, Western Europe, the Middle East and Oceania, found that U.S. clinicians spent an average of 90 minutes a day actively using the EHR – compared with non-U.S. clinicians, who spent about an hour a day in their EHRs.  

Meanwhile, the Medical Care study analyzed primary care exam lengths using EHR time stamps, finding that the average exam time lasted 1.2 minutes longer than scheduled.

The findings for both studies suggest inefficiencies, both in terms of scheduling logistics and within the EHR itself.   

“Time-stamped EHR data offer researchers and health systems an opportunity to measure exam length and other objects of interest related to time,” wrote the researchers in the Medical Care study.  


For the JAMA article, researchers from Harvard and Stanford University analyzed the deidentified Epic Systems metadata of 371 ambulatory care health systems around the world.   

The sample included all clinicians with scheduled patient appointments, including physicians and advanced practice practitioners.  

The study found that U.S. clinicians spent significantly more time than those not in the United States performing four clinical activities: notes, orders, in-basket messages and clinical review.   

U.S. clinicians composed more automated note text and received an average of 34 messages a day, compared with the non-U.S. clinicians’ 13.  

“Furthermore, U.S. clinicians used the EHR for a longer time after hours, logging in 26.5 minutes per day vs. 19.5 minutes per day for non-U.S. clinicians,” wrote the researchers.  

But how do all those minutes in the EHR translate to time spent with patients? The Medical Care article offers some insight.  

In that study, led by researchers from the University of Minnesota, the Urban Institute and the EHR vendor athenahealth, the team calculated exam length and schedule deviations of 21 million primary care visits in 2017.  

The team found that the average primary care exam was 18 minutes, and that visits scheduled for 10 or 15 minutes were more likely to exceed their allotted time than those scheduled for 20 or 30 minutes.  

“Primary care offices’ overuse of brief appointment slots may lead to appointment overrun, increasing wait time for patients and overburdening providers,” wrote the researchers.  


Researchers are increasingly examining the time spent in EHRs as potentially harbingers for clinician burnout.

For instance, a research letter in the Journal of the American Medical Informatics Association this past week found that female clinicians spend 33 more minutes per day in the EHR than male ones.  

“These data suggest that measuring time spent on paid work without accounting for time outside of scheduled hours may underestimate female physician work effort,” said the researchers.

Even so, the EHR market is only getting stronger. A report published this past month predicted that it would grow 6% per year through 2025.


“This study found that U.S. clinicians compared with their non-U.S. counterparts spent substantially more time actively using the EHR for a wide range of clinical activities or tasks,” wrote the JAMA study researchers.   

“This finding suggests that U.S. clinicians have a greater EHR burden that may be associated with nontechnical factors, which policymakers and health system leaders should consider when addressing clinician wellness,” they continued.

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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