JMIR Publications

ABSTRACT

Background:

Telemedicine as a mode of healthcare work has grown dramatically during the COVID-19 pandemic; the impact of this transition on clinicians’ after-hours EHR-based clinical and administrative work is unclear.

Objective:

This study assesses the impact of the transition to telemedicine work during the COVID-19 pandemic on physicians’ EHR-based after-hours workload (“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 during the pre-pandemic, acute pandemic, and post-acute pandemic periods, relating EHR-based work after work to telemedicine intensity (percentage of care provided via telemedicine), and clinical load (patient load per provider).

Results:

2,129 physicians were included in this study. During the acute pandemic, the volume of care provided via telemedicine significantly increased across all physicians, while patient volume decreased. When normalizing for clinical load (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 in the post-acute period.

Conclusions:

Taking physicians’ clinical load into account, physicians who devoted a higher proportion of their clinical time to telemedicine throughout the various stages of the pandemic engaged in higher levels of EHR-based after-hours than 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. Clinical Trial: N/a