{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,19]],"date-time":"2026-09-19T19:02:13Z","timestamp":1789844533266,"version":"4.0.1"},"reference-count":30,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2026,9,19]],"date-time":"2026-09-19T00:00:00Z","timestamp":1789776000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,9,19]],"date-time":"2026-09-19T00:00:00Z","timestamp":1789776000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/100009457","name":"American Medical Association","doi-asserted-by":"publisher","award":["SPO345980"],"award-info":[{"award-number":["SPO345980"]}],"id":[{"id":"10.13039\/100009457","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["AEM Education and Training"],"published-print":{"date-parts":[[2026,10]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>The evolution of electronic health record (EHR) burden throughout emergency medicine (EM) residency remains poorly understood. We aimed to quantify EHR use, the composition of work performed outside scheduled hours, and the development of EHR efficiency across EM training.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Retrospective cohort study of EM residents (postgraduate year [PGY] 1\u20134) using 5.5\u2009years of EHR audit log data (January 2020\u2014June 2025) at a single academic institution. We analyzed EHR time per new patient encounter by PGY, categorized by activity and work during and after scheduled shifts.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The analysis included 155,885 resident\u2010encounters from 133 residents across 14,811 shifts. Encounter\u2010attributed EHR time per encounter decreased by 51% from PGY\u20101 to PGY\u20104 (median 19.7 to 9.7\u2009min,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001) while patient volume per shift increased 71% (median 7 to 12 encounters). Concurrently, documentation time decreased 69% (9.3 to 2.9\u2009min). Total EHR time per shift increased across training. Per\u2010shift documentation time fell (69.2 to 37.0\u2009min), while tracking board time nearly doubled (43.8 to 81.5\u2009min), driven by on\u2010shift use rising from 41.0 to 78.6\u2009min. Work occurring outside any scheduled shift was modest and did not increase monotonically with training (median 7.8, 13.7, 12.3, and 7.3\u2009min per shift for PGY\u20101 through PGY\u20104;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.027), and was predominantly documentation (41%\u201351% of unscheduled minutes). Counting all activity in the 48\u2009h after a shift, without excluding time the resident was scheduled to work, yielded substantially higher estimates (61.9 to 103.5\u2009min per shift).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>EM residents achieve substantial gains in per\u2010encounter EHR efficiency, largest in documentation, but rising patient volume means total EHR time per shift increases rather than falls. Work performed outside scheduled hours is limited and is principally documentation, at least at this single institution. Monitoring these metrics may help programs identify struggling learners and evaluate interventions.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/aet2.70253","type":"journal-article","created":{"date-parts":[[2026,9,19]],"date-time":"2026-09-19T18:19:29Z","timestamp":1789841969000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Running to Stand Still:\n                    <scp>EHR<\/scp>\n                    Efficiency and Workload Across Emergency Medicine Residency"],"prefix":"10.1002","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3856-0068","authenticated-orcid":false,"given":"Carl","family":"Preiksaitis","sequence":"first","affiliation":[{"name":"Department of Emergency Medicine Stanford University School of Medicine  Stanford California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Josh","family":"Hughes","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine Stanford University School of Medicine  Stanford California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4446-2488","authenticated-orcid":false,"given":"Mark","family":"Iscoe","sequence":"additional","affiliation":[{"name":"Department of Biomedical Informatics and Data Science Yale School of Medicine  New Haven Connecticut USA"},{"name":"Department of Emergency Medicine Yale School of Medicine  New Haven Connecticut USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5973-6301","authenticated-orcid":false,"given":"Michael","family":"Makutonin","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine Yale School of Medicine  New Haven Connecticut USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5460-2694","authenticated-orcid":false,"given":"Ashley","family":"Rider","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine Stanford University School of Medicine  Stanford California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6509-9537","authenticated-orcid":false,"given":"Edward R.","family":"Melnick","sequence":"additional","affiliation":[{"name":"Department of Biomedical Informatics and Data Science Yale School of Medicine  New Haven Connecticut USA"},{"name":"Department of Emergency Medicine Yale School of Medicine  New Haven Connecticut USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5115-649X","authenticated-orcid":false,"given":"Christian","family":"Rose","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine Stanford University School of Medicine  Stanford California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,9,19]]},"reference":[{"issue":"10","key":"e_1_2_11_2_1","doi-asserted-by":"crossref","first-page":"1212","DOI":"10.1001\/jamainternmed.2024.4123","article-title":"Physician EHR Time and Visit Volume Following Adoption of Team\u2010Based Documentation Support","volume":"184","author":"Apathy N. C.","year":"2024","journal-title":"JAMA Internal Medicine"},{"issue":"11","key":"e_1_2_11_3_1","doi-asserted-by":"crossref","first-page":"1538","DOI":"10.1377\/hlthaff.2024.00398","article-title":"Electronic Health Record Documentation Burden Crowds Out Health Information Exchange Use by Primary Care Physicians","volume":"43","author":"Holmgren A. J.","year":"2024","journal-title":"Health Affairs"},{"issue":"2","key":"e_1_2_11_4_1","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0280251","article-title":"Predicting Physician Departure With Machine Learning on EHR Use Patterns: A Longitudinal Cohort From a Large Multi\u2010Specialty Ambulatory Practice","volume":"18","author":"Lopez K.","year":"2023","journal-title":"PLoS One"},{"issue":"4","key":"e_1_2_11_5_1","doi-asserted-by":"crossref","first-page":"788","DOI":"10.1055\/s-0041-1733909","article-title":"Interaction Time With Electronic Health Records: A Systematic Review","volume":"12","author":"Pinevich Y.","year":"2021","journal-title":"Applied Clinical Informatics"},{"issue":"8","key":"e_1_2_11_6_1","doi-asserted-by":"crossref","DOI":"10.1001\/jamanetworkopen.2024.27389","article-title":"Benchmarking Emergency Physician EHR Time Per Encounter Based on Patient and Clinical Factors","volume":"7","author":"Iscoe M. S.","year":"2024","journal-title":"JAMA Network Open"},{"issue":"2","key":"e_1_2_11_7_1","doi-asserted-by":"crossref","DOI":"10.1002\/emp2.12923","article-title":"Accuracy of Physician Self\u2010Estimation of Time Spent During Patient Care in the Emergency Department","volume":"4","author":"Reznek M. A.","year":"2023","journal-title":"Journal of the American College of Emergency Physicians Open"},{"issue":"1","key":"e_1_2_11_8_1","doi-asserted-by":"crossref","first-page":"128","DOI":"10.1001\/jamainternmed.2015.6559","article-title":"Computers in the Examination Room","volume":"176","author":"Frankel R. M.","year":"2016","journal-title":"JAMA Internal Medicine"},{"issue":"3","key":"e_1_2_11_9_1","doi-asserted-by":"crossref","first-page":"169","DOI":"10.7326\/M18-3684","article-title":"Physician Time Spent Using the Electronic Health Record During Outpatient Encounters","volume":"172","author":"Overhage J. M.","year":"2020","journal-title":"Annals of Internal Medicine"},{"issue":"7","key":"e_1_2_11_10_1","doi-asserted-by":"crossref","first-page":"1383","DOI":"10.1093\/jamia\/ocab011","article-title":"Characterizing Physician EHR Use With Vendor Derived Data: A Feasibility Study and Cross\u2010Sectional Analysis","volume":"28","author":"Melnick E. R.","year":"2021","journal-title":"Journal of the American Medical Informatics Association"},{"key":"e_1_2_11_11_1","first-page":"1","article-title":"Peripheral Activities During EMR Use in Emergency Care: A Case Study","volume":"2009","author":"Abraham J.","year":"2009","journal-title":"AMIA Annual Symposium Proceedings"},{"issue":"1","key":"e_1_2_11_12_1","doi-asserted-by":"crossref","DOI":"10.1002\/emp2.12362","article-title":"The Impact of Adoption of an Electronic Health Record on Emergency Physician Work: A Time Motion Study","volume":"2","author":"Calder\u2010Sprackman S.","year":"2021","journal-title":"Journal of the American College of Emergency Physicians Open"},{"issue":"4","key":"e_1_2_11_13_1","doi-asserted-by":"crossref","first-page":"462","DOI":"10.1016\/j.annemergmed.2008.09.018","article-title":"Time Motion Study in a Pediatric Emergency Department Before and After Computer Physician Order Entry","volume":"53","author":"Yen K.","year":"2009","journal-title":"Annals of Emergency Medicine"},{"key":"e_1_2_11_14_1","doi-asserted-by":"publisher","DOI":"10.1002\/aet2.10697"},{"issue":"4","key":"e_1_2_11_15_1","doi-asserted-by":"crossref","first-page":"721","DOI":"10.1055\/s-0041-1732403","article-title":"Resident Physician Experience and Duration of Electronic Health Record Use","volume":"12","author":"Holmgren A. J.","year":"2021","journal-title":"Applied Clinical Informatics"},{"issue":"3","key":"e_1_2_11_16_1","doi-asserted-by":"crossref","first-page":"784","DOI":"10.1093\/jamia\/ocad254","article-title":"Guidance for Reporting Analyses of Metadata on Electronic Health Record Use","volume":"31","author":"Rule A.","year":"2024","journal-title":"Journal of the American Medical Informatics Association"},{"issue":"3","key":"e_1_2_11_17_1","doi-asserted-by":"crossref","first-page":"480","DOI":"10.1093\/jamia\/ocz196","article-title":"Using Electronic Health Record Audit Logs to Study Clinical Activity: A Systematic Review of Aims, Measures, and Methods","volume":"27","author":"Rule A.","year":"2020","journal-title":"Journal of the American Medical Informatics Association"},{"issue":"4","key":"e_1_2_11_18_1","doi-asserted-by":"crossref","first-page":"639","DOI":"10.1093\/jamia\/ocz223","article-title":"Metrics for Assessing Physician Activity Using Electronic Health Record Log Data","volume":"27","author":"Sinsky C. A.","year":"2020","journal-title":"Journal of the American Medical Informatics Association"},{"issue":"2","key":"e_1_2_11_19_1","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0205379","article-title":"Characterizing Electronic Health Record Usage Patterns of Inpatient Medicine Residents Using Event Log Data","volume":"14","author":"Wang J. K.","year":"2019","journal-title":"PLoS One"},{"issue":"5","key":"e_1_2_11_20_1","doi-asserted-by":"crossref","first-page":"1056","DOI":"10.1016\/j.jsurg.2020.03.008","article-title":"Surgery Resident Time Consumed by the Electronic Health Record","volume":"77","author":"Maloney S. R.","year":"2020","journal-title":"Journal of Surgical Education"},{"issue":"1","key":"e_1_2_11_21_1","doi-asserted-by":"crossref","first-page":"39","DOI":"10.4300\/JGME-D-15-00240.1","article-title":"Racing Against the Clock: Internal Medicine Residents' Time Spent on Electronic Health Records","volume":"8","author":"Chen L.","year":"2016","journal-title":"Journal of Graduate Medical Education"},{"issue":"1","key":"e_1_2_11_22_1","doi-asserted-by":"crossref","DOI":"10.1370\/afm.22.s1.6628","article-title":"Pajama Time: The Association of EHR Documentation Time With Family Medicine Resident Outcomes","volume":"22","author":"Barr W.","year":"2024","journal-title":"Annals of Family Medicine"},{"issue":"2","key":"e_1_2_11_23_1","doi-asserted-by":"crossref","first-page":"185","DOI":"10.1016\/j.annemergmed.2016.11.020","article-title":"Modeling Hourly Resident Productivity in the Emergency Department","volume":"70","author":"Joseph J. W.","year":"2017","journal-title":"Annals of Emergency Medicine"},{"key":"e_1_2_11_24_1","doi-asserted-by":"publisher","DOI":"10.1093\/jamiaopen\/ooaf042"},{"issue":"2","key":"e_1_2_11_25_1","doi-asserted-by":"crossref","first-page":"453","DOI":"10.1007\/s10459-022-10167-x","article-title":"Documentation as Composing: How Medical Students and Residents Use Writing to Think and Learn","volume":"28","author":"Bowker D.","year":"2022","journal-title":"Advances in Health Sciences Education"},{"key":"e_1_2_11_26_1","article-title":"The Hidden Work of the Note: What Ambient Scribes Ask us to Decide","author":"Preiksaitis C.","year":"2026","journal-title":"Journal of Graduate Medical Education"},{"key":"e_1_2_11_27_1","unstructured":"Centers for Medicare & Medicaid Services \u201cMedicare Program; CY 2023 Payment Policies Under the Physician Fee Schedule and Other Changes to Part B Payment and Coverage Policies \u201dhttps:\/\/www.federalregister.gov\/documents\/2022\/11\/18\/2022\u201023873\/medicare\u2010program\u2010cy\u20102023\u2010payment\u2010policies\u2010under\u2010the\u2010physician\u2010fee\u2010schedule\u2010and\u2010other\u2010changes\u2010to."},{"issue":"2","key":"e_1_2_11_28_1","doi-asserted-by":"crossref","first-page":"331","DOI":"10.1055\/s-0039-1688753","article-title":"Local Investment in Training Drives Electronic Health Record User Satisfaction","volume":"10","author":"Longhurst C.","year":"2019","journal-title":"Applied Clinical Informatics"},{"issue":"16","key":"e_1_2_11_29_1","doi-asserted-by":"crossref","first-page":"1408","DOI":"10.1001\/jama.2026.2253","article-title":"Changes in Clinician Time Expenditure and Visit Quantity With Adoption of Artificial Intelligence\u2013Powered Scribes","volume":"335","author":"Rotenstein L. S.","year":"2026","journal-title":"Journal of the American Medical Association"},{"issue":"5","key":"e_1_2_11_30_1","doi-asserted-by":"crossref","first-page":"569","DOI":"10.1016\/j.annemergmed.2025.12.017","article-title":"Ambient Artificial Intelligence Scribe Adoption and Documentation Time in the Emergency Department","volume":"87","author":"Preiksaitis C.","year":"2026","journal-title":"Annals of Emergency Medicine"},{"issue":"4","key":"e_1_2_11_31_1","doi-asserted-by":"crossref","first-page":"383","DOI":"10.4300\/JGME-D-26-00700.1","article-title":"The Case for Educational Informatics in Graduate Medical Education","volume":"18","author":"Preiksaitis C.","year":"2026","journal-title":"Journal of Graduate Medical Education"}],"container-title":["AEM Education and Training"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/aet2.70253","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/aet2.70253","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/aet2.70253","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,19]],"date-time":"2026-09-19T18:19:35Z","timestamp":1789841975000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/aet2.70253"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,19]]},"references-count":30,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2026,10]]}},"alternative-id":["10.1002\/aet2.70253"],"URL":"https:\/\/doi.org\/10.1002\/aet2.70253","archive":["Portico"],"relation":{},"ISSN":["2472-5390","2472-5390"],"issn-type":[{"value":"2472-5390","type":"print"},{"value":"2472-5390","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,19]]},"assertion":[{"value":"2026-05-20","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-09-04","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-09-19","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e70253"}}