Differences in physician electronic health record use by telemedicine intensity: evidence from 2 academic medical centers

Objective: Evaluate the association between telemedicine intensity and ambulatory physician electronic health record (EHR) use following the COVID-19 pandemic. Materials and Methods: This retrospective study included ambulatory physicians in 11 specialties at 2 large academic medical centers (Washington University in St Louis [WashU], University of California San Francisco [UCSF]). EHR use measures, including time-based and frequency-based, were analyzed in the post-COVID-19 period (March 1, 2021, through March 7, 2022). Multivariable regression models with 2-way fixed effects were used to assess the association between telemedicine intensity and EHR use. Results: Fully telemedicine physician-weeks were associated with higher EHR (hours per 8 patient scheduled hours; β ¼ 3.2 at WashU, β ¼ 1.4 at UCSF; P < .001) and documentation time (β ¼ 2.7 at WashU, β ¼ 1.4 at UCSF; P < .001). Several differences in discrete EHR-based tasks were observed: fully telemedicine physician-days were associated with lesser ordering, and there were mixed patterns for information seeking and clinical communication tasks. Discussion: Expanded use of telemedicine was associated with significant changes in physician EHR use post-COVID-19 onset. Increased EHR time may suggest a shift in workload, whereas decreased ordering may suggest constraints in virtual care, such as ability to perform physical examination and the reliance on patient-reported symptoms. Institutional differences usage patterns suggest that telemedicine’s impact is context-specific and provides opportunities for understanding how to optimize EHRs to support telemedicine. Conclusion: Telemedicine shifts physician EHR. Supporting physicians through optimized EHR tools, tailored workflows, and team-based interventions is essential for sustainable virtual care delivery without exacerbating EHR burden.