title: Monitoring the pulse of hospital activity: electronic health record utilization as a measure of care intensity.
abstract: BACKGROUND
  Hospital care on weekends has been associated with reduced quality and poor clinical outcomes, suggesting that decreases in overall intensity of care may have important clinical effects. We describe a new measure of hospital intensity of care based on utilization of the electronic health record (EHR).
  
  
  METHODS
  We measured global intensity of care at our academic medical center by monitoring the use of the EHR in 2011. Our primary measure, termed EHR interactions, was the number of accessions of a patient's electronic record by a clinician, adjusted for hospital census, per unit of time. Our secondary measure was percent of total available central processing unit (CPU) power used to access EHR servers at a given time.
  
  
  RESULTS
  EHR interactions were lower on weekend days as compared to weekdays at every hour (P < 0.0001), and the daytime peak in intensity noted each weekday was blunted on weekends. The relative rate and 95% confidence interval (CI) of census-adjusted record accessions per patient on weekdays compared with weekends were: 1.76 (95% CI: 1.74-1.77), 1.52 (95% CI: 1.50-1.55), and 1.14 (95% CI: 1.12-1.17) for day, morning/evening, and night hours, respectively. Percent CPU usage correlated closely with EHR interactions (r = 0.90).
  
  
  CONCLUSIONS
  EHR usage is a valid and easily reproducible measure of intensity of care in the hospital. Using this measure we identified large, hour-specific differences between weekend and weekday intensity. EHR interactions may serve as a useful measure for tracking and improving temporal variations in care that are common, and potentially deleterious, in hospital systems.
authors.affiliation: Department of Population Health, New York University School of Medicine, New York, New York; Department of Medicine, New York University Langone Medical Center, New York, New York.
authors.forename: Saul
authors.initials: S
authors.lastname: Blecker
authors.forename: Jonathan S
authors.initials: JS
authors.lastname: Austrian
authors.forename: Daniel
authors.initials: D
authors.lastname: Shine
authors.forename: R Scott
authors.initials: RS
authors.lastname: Braithwaite
authors.forename: Martha J
authors.initials: MJ
authors.lastname: Radford
authors.forename: Marc N
authors.initials: MN
authors.lastname: Gourevitch
mesh_terms: D000046:Academic Medical Centers / Q000639:trends*; D057286:Electronic Health Records / Q000706:statistics & numerical data* / Q000639:trends*; D006282:Health Personnel / Q000639:trends*; D006801:Humans; D011787:Quality of Health Care / Q000639:trends*; D012189:Retrospective Studies