{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T08:23:03Z","timestamp":1787818983599,"version":"build-2784847793"},"reference-count":28,"publisher":"JMIR Publications Inc.","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Med Internet Res"],"abstract":"Abstract<\/jats:title>\n \n Background<\/jats:title>\n Studies suggest that the introduction of electronic health records (EHRs) has decreased the efficiency of clinical practice and increased clinician workload for US-based physicians. Most studies involve clinicians in primary care settings. Less is known about other health care settings, subspecialist clinicians, or whether markers of efficiency and workload change over time.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n This study aimed to describe 2 common metrics of after-hours use of the EHR (pajama time and time outside scheduled hours [TOSH]) among diverse specialists and track these parameters longitudinally in a Canadian setting.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n In this longitudinal descriptive study, medical and surgical specialists were observed starting from the introduction of a system-wide EHR in 2019 to 2022 at a large quaternary teaching hospital in Edmonton, Alberta. Pajama time and TOSH were extracted from the EHR on an Epic system platform and monitored over time. Clinicians were stratified according to clinical group (medical and surgical) and workload (clinical full-time equivalent).<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n A total of 71 medical and surgical specialists participated in this study, spending approximately 24 to 40 minutes per day on pajama time and 32 to 55 minutes per day on TOSH depending on clinician grouping. Both metrics increased over the observation period, as reflected in the longitudinal plots and the higher values observed at the end vs the beginning of follow-up.<\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n After-hours EHR use in this Canadian cohort of medical and surgical specialists was similar to what is reported in the US literature, although the drivers may be different. Perhaps surprisingly, these markers increased over time despite presumed improved familiarity with the EHR. The extent to which this affects clinician well-being and work-life integration cannot be determined from these results, although there may be cause for concern.<\/jats:p>\n <\/jats:sec>","DOI":"10.2196\/76872","type":"journal-article","created":{"date-parts":[[2026,2,24]],"date-time":"2026-02-24T14:10:06Z","timestamp":1771942206000},"page":"e76872-e76872","source":"Crossref","is-referenced-by-count":1,"title":["After-Hours Use of the Electronic Health Record Among Medical and Surgical Specialists After Implementation of a System-Wide Integrated Clinical Information System in Alberta, Canada: Longitudinal Descriptive Study"],"prefix":"10.2196","volume":"28","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9642-5315","authenticated-orcid":false,"given":"Robert P","family":"Pauly","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6679-7823","authenticated-orcid":false,"given":"Tania","family":"Stafinski","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-8279-2872","authenticated-orcid":false,"given":"Helia","family":"Koosha","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7932-4590","authenticated-orcid":false,"given":"Melita","family":"Avdagovska","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7038-6450","authenticated-orcid":false,"given":"Maliheh","family":"Hadizadeh","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2285-4173","authenticated-orcid":false,"given":"David","family":"Bigam","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7896-4561","authenticated-orcid":false,"given":"Timothy","family":"Graham","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3904-5372","authenticated-orcid":false,"given":"Craig","family":"Kuziemsky","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9920-3849","authenticated-orcid":false,"given":"Narmin","family":"Kassam","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4172-8634","authenticated-orcid":false,"given":"Devidas","family":"Menon","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1010","published-online":{"date-parts":[[2026,4,15]]},"reference":[{"issue":"12","key":"R1","doi-asserted-by":"publisher","first-page":"12","DOI":"10.3390\/life10120327","article-title":"Effects of electronic health record implementation and barriers to adoption and use: a scoping review and qualitative analysis of the content","volume":"10","author":"Tsai","journal-title":"Life (Basel)"},{"issue":"12","key":"R2","doi-asserted-by":"publisher","DOI":"10.2196\/26323","article-title":"Value of the electronic medical record for hospital care: update from the literature","volume":"23","author":"Uslu","journal-title":"J Med Internet Res"},{"issue":"8","key":"R3","doi-asserted-by":"publisher","first-page":"827","DOI":"10.1016\/j.healthpol.2018.05.014","article-title":"The impact of electronic health record systems on clinical documentation times: a systematic review","volume":"122","author":"Baumann","journal-title":"Health Policy"},{"issue":"1","key":"R4","doi-asserted-by":"publisher","DOI":"10.1186\/s12911-021-01548-0","article-title":"Persisting workarounds in electronic health record system use: types, risks and benefits","volume":"21","author":"Boonstra","journal-title":"BMC Med Inform Decis Mak"},{"issue":"3","key":"R5","doi-asserted-by":"crossref","first-page":"499","DOI":"10.1037\/0021-9010.86.3.499","volume":"86","author":"Demerouti","journal-title":"J Appl Psychol"},{"issue":"11","key":"R6","doi-asserted-by":"publisher","first-page":"753","DOI":"10.7326\/M16-0961","article-title":"Allocation of physician time in ambulatory practice: a time and motion study in 4 specialties","volume":"165","author":"Sinsky","journal-title":"Ann Intern Med"},{"issue":"5","key":"R7","doi-asserted-by":"publisher","first-page":"419","DOI":"10.1370\/afm.2121","article-title":"Tethered to the EHR: primary care physician workload assessment using EHR event log data and time-motion observations","volume":"15","author":"Arndt","journal-title":"Ann Fam Med"},{"issue":"4","key":"R8","doi-asserted-by":"publisher","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","journal-title":"J Am Med Inform Assoc"},{"issue":"3","key":"R9","doi-asserted-by":"publisher","first-page":"491","DOI":"10.1016\/j.mayocp.2021.11.021","article-title":"Changes in burnout and satisfaction with work-life integration in physicians and the general US working population between 2011 and 2020","volume":"97","author":"Shanafelt","journal-title":"Mayo Clin Proc"},{"key":"R10","unstructured":"CMA 2021 National Physician Health Survey. Canadian Medical Association; 2022. URL: https:\/\/digitallibrary.cma.ca\/link\/digitallibrary17 [Accessed 16-03-2026]"},{"issue":"1","key":"R11","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2019-031765","article-title":"Resilience, burnout and coping mechanisms in UK doctors: a cross-sectional study","volume":"10","author":"McKinley","journal-title":"BMJ Open"},{"issue":"11","key":"R12","doi-asserted-by":"publisher","first-page":"1131","DOI":"10.1001\/jama.2018.12777","article-title":"Prevalence of burnout among physicians: a systematic review","volume":"320","author":"Rotenstein","journal-title":"JAMA"},{"issue":"e1","key":"R13","doi-asserted-by":"publisher","first-page":"e100","DOI":"10.1136\/amiajnl-2013-001875","article-title":"Electronic medical records and physician stress in primary care: results from the MEMO Study","volume":"21","author":"Babbott","journal-title":"J Am Med Inform Assoc"},{"issue":"3","key":"R14","doi-asserted-by":"publisher","first-page":"476","DOI":"10.1016\/j.mayocp.2019.09.024","article-title":"The association between perceived electronic health record usability and professional burnout among US physicians","volume":"95","author":"Melnick","journal-title":"Mayo Clin Proc"},{"issue":"7","key":"R15","doi-asserted-by":"publisher","DOI":"10.2196\/19274","article-title":"The influence of electronic health record use on physician burnout: cross-sectional survey","volume":"22","author":"Tajirian","journal-title":"J Med Internet Res"},{"issue":"8","key":"R16","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2022-060865","article-title":"Electronic medical record-related burnout in healthcare providers: a scoping review of outcomes and interventions","volume":"12","author":"Li","journal-title":"BMJ Open"},{"issue":"2","key":"R17","doi-asserted-by":"publisher","first-page":"157","DOI":"10.1002\/smi.2849","article-title":"Cross-sectional survey of workplace stressors associated with physician burnout measured by the Mini-Z and the Maslach Burnout Inventory","volume":"35","author":"Olson","journal-title":"Stress Health"},{"issue":"5","key":"R18","doi-asserted-by":"publisher","first-page":"938","DOI":"10.1093\/jamia\/ocaa349","article-title":"The impact of time spent on the electronic health record after work and of clerical work on burnout among clinical faculty","volume":"28","author":"Peccoralo","journal-title":"J Am Med Inform Assoc"},{"issue":"4","key":"R19","doi-asserted-by":"publisher","first-page":"531","DOI":"10.1093\/jamia\/ocz220","article-title":"Electronic health records and burnout: time spent on the electronic health record after hours and message volume associated with exhaustion but not with cynicism among primary care clinicians","volume":"27","author":"Adler-Milstein","journal-title":"J Am Med Inform Assoc"},{"issue":"5","key":"R20","doi-asserted-by":"publisher","first-page":"923","DOI":"10.1093\/jamia\/ocaa229","article-title":"Physicians\u2019 electronic inbox work patterns and factors associated with high inbox work duration","volume":"28","author":"Akbar","journal-title":"J Am Med Inform Assoc"},{"key":"R21","doi-asserted-by":"publisher","DOI":"10.2196\/53122","article-title":"Exploring the impact of in basket metrics on the adoption of a new electronic health record system among specialists in a tertiary hospital in Alberta: descriptive study","volume":"26","author":"Avdagovska","journal-title":"J Med Internet Res"},{"issue":"3","key":"R22","doi-asserted-by":"publisher","DOI":"10.2196\/13779","article-title":"Factors associated with electronic health record usage among primary care physicians after hours: retrospective cohort study","volume":"6","author":"Attipoe","journal-title":"JMIR Hum Factors"},{"issue":"5","key":"R23","doi-asserted-by":"publisher","DOI":"10.2196\/34787","article-title":"Characterization of electronic health record use outside scheduled clinic hours among primary care pediatricians: retrospective descriptive task analysis of electronic health record access log data","volume":"10","author":"Attipoe","journal-title":"JMIR Med Inform"},{"issue":"2","key":"R24","doi-asserted-by":"publisher","first-page":"251","DOI":"10.1001\/jamainternmed.2020.7071","article-title":"Assessment of electronic health record use between US and non-US health systems","volume":"181","author":"Holmgren","journal-title":"JAMA Intern Med"},{"issue":"3","key":"R25","doi-asserted-by":"publisher","first-page":"264","DOI":"10.1370\/afm.2960","article-title":"Refining vendor-defined measures to accurately quantify EHR workload outside time scheduled with patients","volume":"21","author":"Arndt","journal-title":"Ann Fam Med"},{"issue":"6","key":"R26","doi-asserted-by":"publisher","first-page":"863","DOI":"10.1001\/jamainternmed.2021.0256","article-title":"Differences in total and after-hours electronic health record time across ambulatory specialties","volume":"181","author":"Rotenstein","journal-title":"JAMA Intern Med"},{"issue":"2","key":"R27","doi-asserted-by":"publisher","first-page":"135","DOI":"10.22454\/FamMed.2020.942762","article-title":"EHR overtime: an analysis of time spent after hours by family physicians","volume":"52","author":"Anderson","journal-title":"Fam Med"},{"issue":"1","key":"R28","doi-asserted-by":"publisher","first-page":"12","DOI":"10.1370\/afm.3047","article-title":"More tethered to the EHR: EHR workload trends among academic primary care physicians, 2019-2023","volume":"22","author":"Arndt","journal-title":"Ann Fam Med"}],"container-title":["Journal of Medical Internet Research"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.jmir.org\/2026\/1\/e76872","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,30]],"date-time":"2026-06-30T18:08:47Z","timestamp":1782842927000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.jmir.org\/2026\/1\/e76872"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4,15]]},"references-count":28,"URL":"https:\/\/doi.org\/10.2196\/76872","relation":{},"ISSN":["1438-8871"],"issn-type":[{"value":"1438-8871","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4,15]]},"article-number":"v28i12e76872"}}