Documenting Progress: Electronic Health Record Burden and Efficiency Across Emergency Medicine Residency Training

Electronic Health Records (EHRs) impose a significant time burden on physicians, often requiring work to be completed outside of scheduled hours. While this burden is well-documented, how it evolves throughout emergency medicine (EM) residency remains poorly understood. This study aimed to quantify EHR usage patterns, analyze the composition of after-shift work, and characterize the development of EHR efficiency across EM training.

We conducted a retrospective cohort study of EM residents (postgraduate year [PGY] 1–4) at a single academic institution using 5.5 years of EHR audit log data (2020–2025). We analyzed EHR time per new patient encounter, stratified by postgraduate year, and categorized activities into domains such as documentation, chart review, and orders. EHR work was measured both during and after scheduled shifts.

The analysis included 148 unique residents and 213,080 new patient encounters. Total EHR time per encounter decreased by 60% from PGY1 to PGY4 (median 13.3 to 5.3 minutes, p<0.001), despite an 80% increase in patient volume per shift. This efficiency gain was driven primarily by an 81% reduction in documentation time (7.7 to 1.4 minutes), which was achieved through writing shorter notes (33% decrease in character count) rather than simply faster entry. After-shift work occurred in over 90% of encounters. While the absolute time spent on after-shift work remained stable across training (median 8–9 minutes), the proportion of work completed after-shift increased from 29% for PGY1s to 38% for PGY4s. Patient tracking activities comprised the majority of after-hours time (67–81%)

EM residents achieve substantial gains in EHR efficiency, driven largely by developing more concise documentation habits. However, a persistent after-hours workload, dominated by administrative and patient flow tasks, suggests that system-level factors, not just individual skill, drive this phenomenon. Monitoring these objective EHR metrics can help programs identify struggling learners and evaluate the impact of interventions aimed at improving resident well-being and workflow efficiency.