Does autotext usage decrease documentation time among resident physicians? A retrospective analysis of electronic health record usage data

doi:10.1093/jamiaopen/ooaf042

Does autotext usage decrease documentation time among resident physicians? A retrospective analysis of electronic health record usage data

2025-05-28

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DOI：10.1093/jamiaopen/ooaf042

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Objective Usage of autotext or dotphrases is ubiquitous among provider workflows in electronic health records (EHRs). Yet, little is known about the impact of these tools in inpatient settings and among resident physicians. We aimed to evaluate the association between autotext usage and documentation time among resident physicians in an academic medical center using the Cerner EHR.Materials and Methods The association between autotext executions and documentation time per patient seen for 705 resident physicians rotating at a large academic medical center from July 2021 to June 2023 was analyzed via linear regression after controlling for specialty, post-graduate year (PGY), provider gender and patient volume.Results There was no significant overall association between autotext executions per patient seen and documentation time per patient seen in specialties using Dynamic Documentation as their primary workflow (beta=-0.1 min per autotext execution per patient seen, 95% CI -0.6 to 0.5 min, P =.79). However, there was increased documentation time among residents with no autotext usage compared to residents who used autotext, and this effect was mediated by use of personalized autotexts. Specialty, PGY, gender and patient volume were significant determinants of documentation time.Discussion Efforts to decrease documentation time among resident physicians should encourage autotext adoption but should not be focused on promotion of autotext usage alone. Further research should address the questions of identifying other determinants of documentation time, autotext design standards, and how autotext usage affects measures of note quality.Conclusion Autotext adoption decreases documentation time among resident physicians, but among those who adopt autotext, higher levels of usage show no benefit. Physicians and other health care providers spend a significant portion of their working day entering documentation into the electronic health record, and the burden of completing documentation is a major cause of burnout. Providers often make use of tools known as autotexts to insert blocks of prepared text into their documentation; autotexts may be either pre-made as part of the system or personalized and customizable. While the intent of autotexts is to allow for faster documentation, there is minimal research available on whether they actually do improve the speed at which documentation is completed, especially in the specific case of resident physicians (physicians who have not yet completed their training). This article studied resident physicians at a single health system. The results showed that while residents who did not use any autotexts at all took longer to document than those who used customizable, personal autotexts, among residents who did use autotexts higher levels of use did not result in statistically meaningful improvements in time spent documenting. These findings suggest that, while customizable, personal autotexts in particular are helpful at low levels of usage, autotexts have rapidly diminishing returns with higher levels of usage and other strategies should also be pursued to reduce documentation burden for resident physicians.

Keywords:

clinical informatics

medical residency

electronic health record

documentation

occupational burnout

Does autotext usage decrease documentation time among resident physicians? A retrospective analysis of electronic health record usage data

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