Specialty and Operator Status Influence Electronic Health Record Use Variation

OBJECTIVES: Electronic health record (EHR) systems are central to modern practice yet contribute to physician workload and burnout. Metrics such as documentation timeliness, efficiency, and after-hours "pajama time" are increasingly used to assess provider performance, but variation across procedural roles and specialties remains understudied. STUDY DESIGN: Cross-sectional study. METHODS: We analyzed 23 months of provider-level EHR data from a single academic health system. Providers with more than 0 operative notes were classified as operators. Six standardized metrics-delayed visit closure, delayed discharge note signing, delayed cosign and verbal order completion, delayed review of high-priority results, mean pajama time, and an institutional proficiency score-were compared between operators and nonoperators using Welch t tests. Subgroup analyses were performed within medicine, obstetrics-gynecology (ob-gyn), and pediatrics. Additional operator comparisons across 6 procedural specialties used analysis of variance. RESULTS: Of 2516 providers, 724 (28.8%) were operators. Operators had higher rates of delayed cosign (9.5% vs 5.7%; P < .001) and verbal order completion (20.5% vs 17.1%; P = .003) but similar pajama time and proficiency compared with nonoperators. In medicine, operators had lower pajama time than nonoperators (21.8 vs 29.2 minutes; P = .006). In pediatrics, operators had fewer delayed discharge notes (P = .035). In ob-gyn, operators showed fewer verbal order and result review delays but higher proficiency and more delayed discharge notes (all P < .05). Among procedural specialties, ophthalmology operators had the highest proficiency yet greater delays across timeliness metrics (all P < .05). CONCLUSIONS: EHR utilization varies by procedural status and specialty, underscoring the need for workflow-specific optimization rather than uniform performance benchmarks.