The implementation of electronic health records (EHRs) has aimed to improve efficiency, reduce costs, and improve data management. However, it has also led to increased clinician workload and growing concerns about well-being. When viewed through the Job Demands–Resources (JD-R) framework, EHRs function both as valuable resources and as significant job demands, potentially worsening cognitive burden and disrupting work–life balance.
A key issue is “after-hours” EHR use, where clinicians complete documentation and administrative tasks outside scheduled working hours, contributing to burnout, particularly in the United States. However, there remains a lack of longitudinal research in non-U.S. healthcare settings, where differences in documentation practices and workflow structures may influence EHR-related workload and its impact on clinicians.
The published study in the Journal of Medical Internet Research aimed to describe and track trends in after-hours electronic health record (EHR) use among surgical and medical specialties following system-wide EHR implementation in a Canadian healthcare setting.
The study focused on two widely used metrics: “pajama time” and time outside scheduled hours (TOSH). It was conducted at the University of Alberta Hospital.
This longitudinal descriptive study analyzed physician EHR activity data from November 2019 to July 2022, spanning nearly three years after the rollout of a comprehensive EHR system (Connect Care, based on the Epic Systems platform).
A total of 71 clinicians from 19 specialties were included. Participants comprised medical and surgical specialists with varying clinical workloads measured in full-time equivalent (FTE). They were categorized into three groups: medical specialists with FTE ≤ 0.5 (38.0%), medical specialists with FTE > 0.5 (36.6%), and surgical specialists with FTE > 0.5 (25.4%). Approximately 39.4% of participants were women.
EHR usage data was obtained by the Signal analytics tool, which captures user activity logs and collects them in monthly metrics. Pajama time was defined as minutes spent on charting outside standard weekday hours (7 AM to 5:30 PM) or during weekends and holidays. TOSH measured total EHR time outside scheduled clinic hours, including a 30-minute buffer around appointments. Data were analyzed descriptively by using monthly weighted averages. Trends were visualized by using moving averages. Limited statistical comparisons were conducted by using the Mann-Whitney U test and interpreted cautiously.
The results showed substantial and increasing after-hours EHR use in all clinician groups. On an average, about 20 to 40 minutes per scheduled day were spent on pajama time by clinicians. About 32 to 55 minutes per day were spent on TOSH. When extrapolated monthly, this corresponds to approximately 11–19 hours of “pajama time” and 15–25 hours of TOSH per clinician. Surgical specialists had higher daily patient volumes and experienced the most pronounced increases in after-hours work. On average, surgical specialists spent 30.1–47.3 minutes per day on pajama time.
Among medical specialists, those with higher clinical workloads (FTE > 0.5) consistently showed greater after-hours EHR use compared to those with lower workloads. In this group, pajama time increased from 26.9 to 34.8 minutes per day, while TOSH increased from 43.1 to 56.4 minutes per day-the highest observed value. Even lower-workload clinicians (FTE ≤ 0.5) demonstrated similar increases, with TOSH rising from 26.5 to 34.8 minutes per day. Overall, all groups showed upward trends in both clinical workload (appointments per day) and after-hours EHR engagement over time.
These findings are significant because they contradict the expectation that elevated familiarity with EHR systems would reduce time burden. After-hours EHR use increased, suggesting that system demands may rise in parallel with clinical workload and that expected efficiency gains are not being fully realized.
Comparisons with U.S.-based studies revealed the same levels of after-hours EHR use, which indicate that systemic differences in documentation needs may not significantly change overall time burden. Comparisons across studies remain challenging because of variability in how after-hours work is defined and measured and differences in specialties, workloads, and EHR platforms.
This study provides important evidence that after-hours EHR use is persistent, substantial, and increasing within a Canadian healthcare setting. The result highlights a growing encroachment of EHR related tasks in clinicians’ personal time, which raises concerns about work life balance and burnout. While the study is descriptive and does not directly link EHR use to well-being outcomes, it underscores the need for system-level interventions to reduce administrative burden, improve EHR usability, and better align job demands with available resources. Addressing these challenges will be important to optimize both clinician experience and healthcare system performance.
Reference: Pauly RP, Stafinski T, Koosha H, et al. After-Hours Use of the Electronic Health Record Among Medical and Surgical Specialists After Implementation of a System-Wide Integrated Clinical Information System in Alberta, Canada: Longitudinal Descriptive Study. J Med Internet Res. 2026;28:e76872. doi:10.2196/76872
