{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,4]],"date-time":"2025-12-04T01:27:54Z","timestamp":1764811674113,"version":"3.37.3"},"reference-count":44,"publisher":"Oxford University Press (OUP)","issue":"6","license":[{"start":{"date-parts":[[2022,3,10]],"date-time":"2022-03-10T00:00:00Z","timestamp":1646870400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2022,5,11]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objective<\/jats:title><jats:p>Clinicians spend significant time working in the electronic health record (EHR). The US is an outlier in EHR time, suggesting that EHR-related work may be driven in part by the legal environment and threat of malpractice. To assess this, we evaluate the association between state-level malpractice climate and clinician time spent in the EHR.<\/jats:p><\/jats:sec><jats:sec><jats:title>Materials and Methods<\/jats:title><jats:p>We use EHR metadata from 351 ambulatory care health systems in the United States using Epic from January\u2013August 2019 combined with state-level data on malpractice incidence and payouts. We used descriptive statistics to measure variation in clinician EHR time, including total EHR time, documentation time per day, and after-hours EHR time per day. Multi-variable regression evaluated the association between clinicians in high malpractice states and EHR use.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>We found no association between location in a state in the top-quartile of malpractice payouts and time spent in the EHR per day, time spent in the EHR outside of scheduled hours, or time spent documenting per day, except for a subgroup of the clinicians in the highest malpractice specialties, where there was a small increase in EHR time per day (B\u2009=\u20096.08 min, P\u2009&amp;lt;\u20090.001) and time spent documenting notes (B\u2009=\u20092.77 min, P\u2009&amp;lt;\u20090.001).<\/jats:p><\/jats:sec><jats:sec><jats:title>Discussion<\/jats:title><jats:p>State-level differences in malpractice incidence are unlikely to be a significant driver of EHR work for most clinicians.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Policymakers seeking to address EHR documentation burden should examine burden driven by other socio-technical demands on clinician time, such as billing or quality measurement.<\/jats:p><\/jats:sec>","DOI":"10.1093\/jamia\/ocac034","type":"journal-article","created":{"date-parts":[[2022,2,25]],"date-time":"2022-02-25T20:11:22Z","timestamp":1645819882000},"page":"1069-1077","source":"Crossref","is-referenced-by-count":9,"title":["Association between state-level malpractice environment and clinician electronic health record (EHR) time"],"prefix":"10.1093","volume":"29","author":[{"given":"A Jay","family":"Holmgren","sequence":"first","affiliation":[{"name":"Department of Medicine, Center for Clinical Informatics and Improvement Research, University of California, San Francisco, San Francisco, California, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lisa","family":"Rotenstein","sequence":"additional","affiliation":[{"name":"Department of General Internal Medicine, Brigham & Women\u2019s Hospital, Harvard Medical School, Boston, Massachusetts, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Norman Lance","family":"Downing","sequence":"additional","affiliation":[{"name":"Department of Medicine, Stanford University, Stanford, California, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6268-1540","authenticated-orcid":false,"given":"David W","family":"Bates","sequence":"additional","affiliation":[{"name":"Department of General Internal Medicine, Brigham & Women\u2019s Hospital, Harvard Medical School, Boston, Massachusetts, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kevin","family":"Schulman","sequence":"additional","affiliation":[{"name":"Department of Medicine, Clinical Excellence Research Center, Stanford University, Stanford, California, 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