One scheduling change sharply reduced after-hours EHR work in physician practices

A new study in JAMA Network Open takes a close look at a simple but increasingly popular idea in physician practices: setting aside protected time during the workday for electronic health record (EHR) tasks.

Instead of pushing inbox work into nights and weekends, one ambulatory network reserved a dedicated appointment slot each half day for activities such as patient messaging, prescription refills and prior authorizations. Researchers tracked what happened to productivity, after-hours work and message volume over nearly three years.

The results suggest that small scheduling changes can have an outsized impact on physician workload. After-hours and weekend EHR time dropped quickly after protected time was introduced, while productivity took only a modest short-term dip and then stabilized.

A new study suggests that carving out protected time for electronic health record (EHR) work can sharply reduce after-hours charting and weekend inbox labor — with only a modest, short-term impact on physician productivity.

The findings come from a study published in JAMA Network Open on Dec. 2, 2025, that examined what happened after a large ambulatory network in the western United States began reserving one appointment slot per half-day for physicians to complete asynchronous EHR work.

The protected slots were used at physicians’ discretion for tasks such as patient messaging, prior authorizations and prescription refills.

Productivity dipped, then stabilized

Researchers analyzed data from 130 general internal medicine physicians working between November 2021 and June 2024. Eighty-nine physicians practiced in a control network, while 41 participated in the protected-time intervention.

After the new scheduling model launched in November 2022, the intervention group saw an immediate decline of about 13 relative value units (RVUs) per week compared with the control group. Over time, however, RVUs began trending upward again, suggesting the early productivity effect did not worsen.

The control group’s productivity remained largely stable throughout the study period.

Nights and weekends improved quickly

Time-stamped EHR log data showed immediate improvements in work-life boundary erosion:

• After-hours EHR use dropped by nearly 25 minutes per week.
• Non-workday EHR use dropped by nearly 29 minutes per week.

Those reductions persisted through the remainder of the study period.

Patient message volume rose briefly after the intervention began but then declined over time.

Burnout fell sharply at the intervention site

Although burnout was not measured across both networks, a pre- and post-intervention survey conducted at the protected-time practice found that physician burnout fell by 81% after implementation, according to the authors.

The study relied on observational methods and included differences in physician full-time equivalency and practice structure between sites, which may limit how broadly the findings apply.

The authors concluded that reserving dedicated time for asynchronous EHR work may reduce administrative burden without fundamentally undermining revenue — at least in fee-for-service, ambulatory settings similar to those studied.

For practice leaders, the study adds weight to a growing argument that EHR burden is not only a software issue, but also a scheduling and staffing issue. How inbox work is structured inside the clinic may matter just as much as which platform the practice runs.

Not all EHR systems support asynchronous workflows equally — and that gap becomes more visible as practices rethink inbox labor.