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Background Telemedicine as a mode of health care work has grown dramatically during the COVID-19 pandemic; the impact of this transition on clinicians’ after-hours electronic health record (EHR)–based clinical and administrative work is unclear. Objective This study assesses the impact of the transition to telemedicine during the COVID-19 pandemic on physicians’ EHR-based after-hours workload (ie, “work outside work”) at a large academic medical center in New York City. Methods We conducted an EHR-based retrospective cohort study of ambulatory care physicians providing telemedicine services before the pandemic, during the acute pandemic, and after the acute pandemic, relating EHR-based after-hours work to telemedicine intensity (ie, percentage of care provided via telemedicine) and clinical load (ie, patient load per provider). Results A total of 2129 physicians were included in this study. During the acute pandemic, the volume of care provided via telemedicine significantly increased for all physicians, whereas patient volume decreased. When normalized by clinical load (ie, average appointments per day by average clinical days per week), telemedicine intensity was positively associated with work outside work across time periods. This association was strongest after the acute pandemic. Conclusions Taking physicians’ clinical load into account, physicians who devoted a higher proportion of their clinical time to telemedicine throughout various stages of the pandemic engaged in higher levels of EHR-based after-hours work compared to those who used telemedicine less intensively. This suggests that telemedicine, as currently delivered, may be less efficient than in-person–based care and may increase the after-hours work burden of physicians.
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Quantifying the impact of telemedicine and patient medical advice request messages on physicians' work-outside-work
Abstract The COVID-19 pandemic has boosted digital health utilization, raising concerns about increased physicians’ after-hours clinical work (work-outside-work”). The surge in patients’ digital messages and additional time spent on work-outside-work by telemedicine providers underscores the need to evaluate the connection between digital health utilization and physicians’ after-hours commitments. We examined the impact on physicians’ workload from two types of digital demands - patients’ messages requesting medical advice (PMARs) sent to physicians’ inbox (inbasket), and telemedicine. Our study included 1716 ambulatory-care physicians in New York City regularly practicing between November 2022 and March 2023. Regression analyses assessed primary and interaction effects of (PMARs) and telemedicine on work-outside-work. The study revealed a significant effect ofPMARs on physicians’ work-outside-work and that this relationship is moderated by physicians’ specialties. Non-primary care physicians or specialists experienced a more pronounced effect than their primary care peers. Analysis of their telemedicine load revealed that primary care physicians received fewerPMARs and spent less time in work-outside-work with more telemedicine. Specialists faced increasedPMARs and did more work-outside-work as telemedicine visits increased which could be due to the difference in patient panels. ReducingPMARvolumes and efficient inbasket management strategies needed to reduce physicians’ work-outside-work. Policymakers need to be cognizant of potential disruptions in physicians carefully balanced workload caused by the digital health services.
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- PAR ID:
- 10490858
- Publisher / Repository:
- Nature Publishing Group
- Date Published:
- Journal Name:
- npj Digital Medicine
- Volume:
- 7
- Issue:
- 1
- ISSN:
- 2398-6352
- Format(s):
- Medium: X
- Sponsoring Org:
- National Science Foundation
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