How to Keep Physicians Out of the EHR During Their Time Off

April 10, 2025 ‐ HealthLeaders Media

By Christopher Cheney

Many physicians are working in the EHR during their time off, according to a new study, and their CMOs need to take steps to stop that.

Research published in JAMA Network Open found that primary care physicians commonly worked in the EHR during their vacations. The article, which collected data from 56 primary care physicians, had several key findings:

The median time in the EHR per day off was 16.1 minutes, with 19% of physicians experiencing more than 30 minutes per day.
Longer durations of days off were associated with less time spent in the EHR. Physicians spent a median of 50% of short vacation days and 18% of long vacation days with some EHR use.
Physicians spent more time in the EHR at the beginning and end of vacations. They spent a median of 57% of first days and 63.5% of last days in the EHR, compared to a median of 29% of middle days in the EHR.
Electronic in-basket work was a common EHR task, with physicians spending a median of 39.5% of total EHR time performing inbox-related tasks.

Sam Weiner, MD, CMO of Virtua Medical Group, says executives are concerned about physicians at Virtua Health‘s medical group working in the EHR during their time off.

“There is a metric that we call time outside of scheduled hours, which is simply how much time physicians are spending in the EHR outside of the patient schedule,” he says. “Our physicians are scheduled to see patients from 8 a.m. to 4:30 p.m.”

“The other euphemism for this is ‘pajama time,’ which is the time physicians spend at night finishing up documentation, answering patient inquiries, and refilling medications,” Weiner adds.

Weiner says the problem is particularly acute with short periods of time off, as opposed to longer vacations.

“When we try to take a four-day weekend, forget it, we are in the EHR the whole time,” Weiner says. “It is only when physicians can take a week or sometimes two weeks off that we truly get that sense of being able to breathe a sigh of relief and finally feel disconnected. That is when physicians can recharge. Unfortunately, those opportunities are few and far between.”

This is also a concern at Ardent Health, according to the Nashville, Tennessee-based health system’s CMIO, Bradley Hoyt, MD.

“It happens all the time,” Hoyt says. “It’s just the way things are. I did it for years.”

Hoyt says this habit is contributing to physician burnout.

Helping physicians curb their off-hours EHR use

Virtua Medical Group has launched several interventions to help physicians cut back on accessing EHRs during time off, particularly for tasks associated with electronic in-basket messaging.

“We have more than two dozen primary care practices, and some of those practices have a coverage system in place for when physicians go out on vacation,” Weiner says. “They have a structured way for the physicians who remain in the practice to cover for the physician who is on vacation. When a physician is out, they can feel confident that their patients will be taken care of.”

Virtua Medical Group also has a strategy that the medical group calls “taming the in-basket.”

“We take a lot of the messages that come in to physicians on a daily basis and screen them to make sure they go to the appropriate staff member,” Weiner says. “Not every message has to go to the doctor—many of them can be fulfilled and completed by other staff members in the office.”

Virtua also hires nurse practitioners to serve as “in-basketologists.”

“Their role throughout the day is to mine the in-baskets of the other clinicians in the practice and take out everything that a doctor does not need to see and handle those messages,” Weiner says.

Nurse practitioners, who are licensed and trained clinicians, can answer clinical questions in a way that medical assistants and even registered nurses sometimes cannot answer, according to Weiner.

“This has been shown to significantly reduce the amount of time that our physicians spend in the EHR outside of their scheduled hours,” Weiner says.

Ardent Health is using AI to tackle the problem. The health system is deploying an ambient AI tool, called Ambience, to capture the doctor-patient conversation and reduce the time providers need to spend in the EHR.

“No provider likes to write notes,” Hoyt says. “It is the bane of our existence. We love talking with patients—we love connecting with them. Having to leave the examine room, then dictate the note before seeing the next patient is a huge weight on the physician’s shoulders.”

“With ambient dictation, we have cut our pajama time by 50% [and] reduced total documentation time by 41%,” Hoyt says. “That is a big win for our providers. They don’t have to work at home as much.”

Christopher Cheney is the CMO editor at HealthLeaders.

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