{"id":"https://openalex.org/W7202253400","doi":"https://doi.org/10.2196/preprints.108756","title":"Trajectories of electronic health record-based workload among inpatient hospitalizations: a retrospective cohort study (Preprint)","display_name":"Trajectories of electronic health record-based workload among inpatient hospitalizations: a retrospective cohort study (Preprint)","publication_year":2026,"publication_date":"2026-08-04","ids":{"openalex":"https://openalex.org/W7202253400","doi":"https://doi.org/10.2196/preprints.108756"},"language":"en","primary_location":{"id":"doi:10.2196/preprints.108756","doi":"https://doi.org/10.2196/preprints.108756","is_oa":false,"landing_page_url":"https://doi.org/10.2196/preprints.108756","pdf_url":null,"source":null,"license":null,"license_id":null,"version":"submittedVersion","is_accepted":false,"is_published":false,"raw_source_name":null,"raw_type":"posted-content"},"volume":null,"type":"preprint","is_traditional":true,"indexed_in":["crossref"],"open_access":{"is_oa":false,"oa_status":"closed","oa_url":null,"any_repository_has_fulltext":false},"authorships":[{"author_position":"first","author":{"id":"https://openalex.org/A5119496954","display_name":"Bailey W. Osweiler","orcid":"https://orcid.org/0009-0005-3179-8136","observed_orcids":["https://orcid.org/0009-0005-3179-8136"]},"institutions":[],"countries":[],"is_corresponding":false,"raw_author_name":"Bailey Wellen Osweiler","raw_affiliation_strings":[],"raw_orcid":"https://orcid.org/0009-0005-3179-8136","affiliations":[]},{"author_position":"middle","author":{"id":"https://openalex.org/A5078854914","display_name":"Laura Rosa Baratta","orcid":"https://orcid.org/0000-0001-8644-9033","observed_orcids":["https://orcid.org/0000-0001-8644-9033"]},"institutions":[],"countries":[],"is_corresponding":false,"raw_author_name":"Laura Rosa Baratta","raw_affiliation_strings":[],"raw_orcid":"https://orcid.org/0000-0001-8644-9033","affiliations":[]},{"author_position":"middle","author":{"id":"https://openalex.org/A5084495648","display_name":"Elise Eiden","orcid":"https://orcid.org/0009-0001-4068-7631","observed_orcids":["https://orcid.org/0009-0001-4068-7631"]},"institutions":[],"countries":[],"is_corresponding":false,"raw_author_name":"Elise Eiden","raw_affiliation_strings":[],"raw_orcid":"https://orcid.org/0009-0001-4068-7631","affiliations":[]},{"author_position":"middle","author":{"id":"https://openalex.org/A5055407158","display_name":"Sunny S. Lou","orcid":"https://orcid.org/0000-0002-4215-605X","observed_orcids":["https://orcid.org/0000-0002-4215-605X"]},"institutions":[],"countries":[],"is_corresponding":false,"raw_author_name":"Sunny S Lou","raw_affiliation_strings":[],"raw_orcid":"https://orcid.org/0000-0002-4215-605X","affiliations":[]},{"author_position":"middle","author":{"id":"https://openalex.org/A5070305373","display_name":"Thomas Kannampallil","orcid":"https://orcid.org/0000-0003-4119-4836","observed_orcids":["https://orcid.org/0000-0003-4119-4836"]},"institutions":[],"countries":[],"is_corresponding":false,"raw_author_name":"Thomas Kannampallil","raw_affiliation_strings":[],"raw_orcid":"https://orcid.org/0000-0003-4119-4836","affiliations":[]},{"author_position":"last","author":{"id":"https://openalex.org/A5066743636","display_name":"Daphne Lew","orcid":"https://orcid.org/0000-0001-5433-2367","observed_orcids":["https://orcid.org/0000-0001-5433-2367"]},"institutions":[],"countries":[],"is_corresponding":false,"raw_author_name":"Daphne Lew","raw_affiliation_strings":[],"raw_orcid":"https://orcid.org/0000-0001-5433-2367","affiliations":[]}],"institutions":[],"countries_distinct_count":0,"institutions_distinct_count":0,"corresponding_author_ids":[],"corresponding_institution_ids":[],"apc_list":null,"apc_paid":null,"fwci":null,"has_fulltext":false,"cited_by_count":0,"citation_normalized_percentile":null,"cited_by_percentile_year":null,"biblio":{"volume":null,"issue":null,"first_page":null,"last_page":null},"is_retracted":false,"is_paratext":false,"is_xpac":false,"primary_topic":{"id":"https://openalex.org/T10350","display_name":"Electronic Health Records Systems","score":0.9678000211715698,"subfield":{"id":"https://openalex.org/subfields/3605","display_name":"Health Information Management"},"field":{"id":"https://openalex.org/fields/36","display_name":"Health Professions"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}},"topics":[{"id":"https://openalex.org/T10350","display_name":"Electronic Health Records Systems","score":0.9678000211715698,"subfield":{"id":"https://openalex.org/subfields/3605","display_name":"Health Information Management"},"field":{"id":"https://openalex.org/fields/36","display_name":"Health Professions"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}},{"id":"https://openalex.org/T12174","display_name":"Hospital Admissions and Outcomes","score":0.023000000044703484,"subfield":{"id":"https://openalex.org/subfields/2911","display_name":"Leadership and Management"},"field":{"id":"https://openalex.org/fields/29","display_name":"Nursing"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}},{"id":"https://openalex.org/T14400","display_name":"Medical Coding and Health Information","score":0.00430000014603138,"subfield":{"id":"https://openalex.org/subfields/3605","display_name":"Health Information Management"},"field":{"id":"https://openalex.org/fields/36","display_name":"Health Professions"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}}],"keywords":[{"id":"https://openalex.org/keywords/electronic-health-records","display_name":"electronic health records","score":0.8820000290870667},{"id":"https://openalex.org/keywords/length-of-hospital-stay","display_name":"length of hospital stay","score":0.8709999918937683},{"id":"https://openalex.org/keywords/hospitalization","display_name":"hospitalization","score":0.6620000004768372},{"id":"https://openalex.org/keywords/discharge-disposition","display_name":"discharge disposition","score":0.7580000162124634},{"id":"https://openalex.org/keywords/skilled-nursing-facilities","display_name":"skilled nursing facilities","score":0.8840000033378601},{"id":"https://openalex.org/keywords/sociodemographic-disparities","display_name":"sociodemographic disparities","score":0.7639999985694885},{"id":"https://openalex.org/keywords/racial-disparities","display_name":"racial disparities","score":0.6399999856948853},{"id":"https://openalex.org/keywords/medicaid","display_name":"Medicaid","score":0.828000009059906},{"id":"https://openalex.org/keywords/black-patients","display_name":"Black patients","score":0.5759999752044678},{"id":"https://openalex.org/keywords/hospital-readmission","display_name":"hospital readmission","score":0.3149999976158142},{"id":"https://openalex.org/keywords/group-based-trajectory-modeling","display_name":"group-based trajectory modeling","score":0.6200000047683716},{"id":"https://openalex.org/keywords/health-care-equity","display_name":"health care equity","score":0.32199999690055847},{"id":"https://openalex.org/keywords/discharge-planning","display_name":"discharge planning","score":0.5460000038146973},{"id":"https://openalex.org/keywords/hospital-capacity","display_name":"hospital capacity","score":0.36399999260902405}],"concepts":[{"id":"https://openalex.org/C2778476105","wikidata":"https://www.wikidata.org/wiki/Q628539","display_name":"Workload","level":2,"score":0.8242999911308289},{"id":"https://openalex.org/C71924100","wikidata":"https://www.wikidata.org/wiki/Q11190","display_name":"Medicine","level":0,"score":0.7839999794960022},{"id":"https://openalex.org/C199521495","wikidata":"https://www.wikidata.org/wiki/Q181487","display_name":"Audit","level":2,"score":0.744700014591217},{"id":"https://openalex.org/C167135981","wikidata":"https://www.wikidata.org/wiki/Q2146302","display_name":"Retrospective cohort study","level":2,"score":0.6255000233650208},{"id":"https://openalex.org/C160735492","wikidata":"https://www.wikidata.org/wiki/Q31207","display_name":"Health care","level":2,"score":0.5741000175476074},{"id":"https://openalex.org/C151956035","wikidata":"https://www.wikidata.org/wiki/Q1132755","display_name":"Logistic regression","level":2,"score":0.5519000291824341},{"id":"https://openalex.org/C2780148112","wikidata":"https://www.wikidata.org/wiki/Q1432581","display_name":"Proxy (statistics)","level":2,"score":0.5349000096321106},{"id":"https://openalex.org/C194828623","wikidata":"https://www.wikidata.org/wiki/Q2861470","display_name":"Emergency medicine","level":1,"score":0.5059999823570251},{"id":"https://openalex.org/C2780358146","wikidata":"https://www.wikidata.org/wiki/Q5908738","display_name":"Hospital medicine","level":2,"score":0.45100000500679016},{"id":"https://openalex.org/C3020144179","wikidata":"https://www.wikidata.org/wiki/Q10871684","display_name":"Electronic health record","level":3,"score":0.4458000063896179},{"id":"https://openalex.org/C545542383","wikidata":"https://www.wikidata.org/wiki/Q2751242","display_name":"Medical emergency","level":1,"score":0.43720000982284546},{"id":"https://openalex.org/C2780084366","wikidata":"https://www.wikidata.org/wiki/Q37732","display_name":"Demographics","level":2,"score":0.43059998750686646},{"id":"https://openalex.org/C195910791","wikidata":"https://www.wikidata.org/wiki/Q1324077","display_name":"Medical record","level":2,"score":0.430400013923645},{"id":"https://openalex.org/C3017624810","wikidata":"https://www.wikidata.org/wiki/Q3259564","display_name":"Hospital discharge","level":2,"score":0.4052000045776367},{"id":"https://openalex.org/C3019952477","wikidata":"https://www.wikidata.org/wiki/Q1324077","display_name":"Health records","level":3,"score":0.39890000224113464},{"id":"https://openalex.org/C2779473830","wikidata":"https://www.wikidata.org/wiki/Q1540899","display_name":"MEDLINE","level":2,"score":0.37470000982284546},{"id":"https://openalex.org/C2779328685","wikidata":"https://www.wikidata.org/wiki/Q1475557","display_name":"Patient safety","level":3,"score":0.3582000136375427},{"id":"https://openalex.org/C2776354556","wikidata":"https://www.wikidata.org/wiki/Q10910281","display_name":"Health information technology","level":3,"score":0.3528999984264374},{"id":"https://openalex.org/C201903717","wikidata":"https://www.wikidata.org/wiki/Q1778788","display_name":"Cohort study","level":2,"score":0.3368000090122223},{"id":"https://openalex.org/C512399662","wikidata":"https://www.wikidata.org/wiki/Q3505712","display_name":"Family medicine","level":1,"score":0.3359000086784363},{"id":"https://openalex.org/C72563966","wikidata":"https://www.wikidata.org/wiki/Q1303415","display_name":"Cohort","level":2,"score":0.3346000015735626},{"id":"https://openalex.org/C2992870097","wikidata":"https://www.wikidata.org/wiki/Q3259564","display_name":"Patient discharge","level":3,"score":0.32739999890327454},{"id":"https://openalex.org/C2988170871","wikidata":"https://www.wikidata.org/wiki/Q11000047","display_name":"Healthcare system","level":3,"score":0.3260999917984009},{"id":"https://openalex.org/C3018060332","wikidata":"https://www.wikidata.org/wiki/Q10871684","display_name":"Electronic medical record","level":2,"score":0.3037000000476837},{"id":"https://openalex.org/C3017977704","wikidata":"https://www.wikidata.org/wiki/Q18745135","display_name":"Health data","level":3,"score":0.2996000051498413},{"id":"https://openalex.org/C3019806175","wikidata":"https://www.wikidata.org/wiki/Q11974939","display_name":"Health professionals","level":3,"score":0.28360000252723694},{"id":"https://openalex.org/C2987381348","wikidata":"https://www.wikidata.org/wiki/Q517656","display_name":"Electronic records","level":2,"score":0.28139999508857727},{"id":"https://openalex.org/C2777896191","wikidata":"https://www.wikidata.org/wiki/Q22907655","display_name":"Patient experience","level":3,"score":0.2761000096797943}],"mesh":[],"locations_count":1,"locations":[{"id":"doi:10.2196/preprints.108756","doi":"https://doi.org/10.2196/preprints.108756","is_oa":false,"landing_page_url":"https://doi.org/10.2196/preprints.108756","pdf_url":null,"source":null,"license":null,"license_id":null,"version":"submittedVersion","is_accepted":false,"is_published":false,"raw_source_name":null,"raw_type":"posted-content"}],"best_oa_location":null,"sustainable_development_goals":[{"score":0.9763000011444092,"display_name":"Good health and well-being","id":"https://metadata.un.org/sdg/3"},{"score":0.4000000059604645,"display_name":"Reduced inequalities","id":"https://metadata.un.org/sdg/10"}],"study_designs":[{"display_name":"Observational Study","id":"https://openalex.org/study-designs/observational-study"}],"awards":[],"funders":[],"has_content":{"grobid_xml":false,"pdf":false},"content_urls":null,"referenced_works_count":0,"referenced_works":[],"related_works":["https://openalex.org/W4281710892","https://openalex.org/W4362547436","https://openalex.org/W4404721555","https://openalex.org/W2971342871","https://openalex.org/W4412568228","https://openalex.org/W7110932867","https://openalex.org/W3028429496","https://openalex.org/W2467874685","https://openalex.org/W3153126098","https://openalex.org/W1997985925"],"abstract_inverted_index":{"BACKGROUND":[0],"The":[1,85,213],"average":[2],"hospital":[3,57,64,110,149],"length":[4],"of":[5,28,77,87,94,153,165,199,299,393],"stay":[6],"(LOS)":[7],"has":[8],"increased":[9,20],"in":[10,369],"recent":[11],"years,":[12],"leading":[13],"to":[14,49,68,91,142,161,290,301,322,351,354],"negative":[15],"outcomes":[16],"for":[17,22,33,316,389,407],"patients":[18,260],"and":[19,25,62,82,99,104,109,172,185,227,257,265,285,318,338,373,375],"costs":[21],"patients,":[23],"hospitals,":[24],"insurers.":[26],"Some":[27],"these":[29,380,400],"prolonged":[30,63],"stays":[31],"are":[32,66,397],"non-medical":[34],"reasons":[35],"such":[36],"as":[37],"discharge":[38,111,186,300],"planning.":[39,410],"Electronic":[40],"health":[41],"record":[42],"(EHR)":[43],"audit":[44,138],"logs":[45,139],"provide":[46],"an":[47],"opportunity":[48],"measure":[50],"healthcare":[51,80,133],"professional":[52],"EHR-based":[53,60,95,154],"workload":[54,61],"during":[55,168],"extended":[56],"stays.":[58],"Both":[59],"LOS":[65,118,251,279],"known":[67],"be":[69,352],"associated":[70],"with":[71,117],"sociodemographic":[72],"disparities,":[73],"emphasizing":[74],"the":[75,88,178,234,277,286,323,394],"importance":[76],"ensuring":[78],"equitable":[79],"access":[81],"outcomes.":[83],"OBJECTIVE":[84],"objective":[86],"study":[89,396],"is":[90],"identify":[92,162],"trajectories":[93,108,184,198,368,402],"workload,":[96],"examine":[97],"clinical":[98,319,376],"socio-demographic":[100,374],"differences":[101],"across":[102,177],"trajectories,":[103],"explore":[105],"relationships":[106],"between":[107,183,311,379,385],"disposition.":[112],"METHODS":[113],"Inpatient":[114],"medicine":[115,371],"hospitalizations":[116,206],"\u2265":[119],"3":[120],"days":[121],"from":[122],"January":[123],"\u2013":[124],"April":[125],"2023":[126],"at":[127],"14":[128],"hospitals":[129],"within":[130],"a":[131,151,355],"large":[132],"system":[134],"were":[135,140,175,188,202,217,262,347,364],"included.":[136],"EHR":[137,144,166,200,246,366],"used":[141,160],"compute":[143],"time":[145,167,201,247,367],"per":[146,148],"patient":[147,408],"day,":[150],"proxy":[152],"workload.":[155],"Group-based":[156],"trajectory":[157,180,312],"modeling":[158],"was":[159],"latent":[163],"patterns":[164],"hospitalization.":[169],"Patient":[170],"demographics":[171,317],"encounter":[173],"characteristics":[174,377],"compared":[176],"identified":[179,203],"groups.":[181],"Associations":[182],"disposition":[187],"examined":[189],"using":[190],"multivariable":[191],"mixed":[192],"effects":[193],"logistic":[194],"regressions.":[195],"RESULTS":[196],"Four":[197],"among":[204],"9537":[205],"(median":[207],"LOS=5.23":[208],"days,":[209,253,281],"IQR":[210,254,282],"3.95,":[211],"7.89).":[212],"two":[214,235],"largest":[215,287,324],"groups":[216,313,386],"\u201cModerate":[218,228,271,326,330,339],"Early":[219],"[EHR":[220,223],"Time]/Low":[221],"Overall":[222],"Time]\u201d":[224],"(n=6812,":[225],"71.4%)":[226],"Early/Moderate":[229,331],"Overall\u201d":[230,240,273,332,341],"(n=2013,":[231],"21.1%).":[232],"Among":[233],"smaller":[236],"groups,":[237],"\u201cHigh":[238],"Early/Low":[239,327],"(n=397,":[241],"4.2%)":[242],"had":[243,266,276],"high":[244],"initial":[245],"(>20":[248],"hours),":[249],"short":[250],"(4.13":[252],"3.54,":[255],"4.89),":[256],"disproportionately":[258],"included":[259],"who":[261],"Black":[263],"(n=202,50.9%)":[264],"Medicaid":[267],"insurance":[268],"(n=105,":[269],"26.4%).":[270],"Early/High":[272,340],"(n=315,":[274],"3.3%)":[275],"longest":[278],"(21.7":[280],"17.8,":[283],"28.5)":[284],"proportion":[288],"discharged":[289,353],"skilled":[291,302],"nursing":[292,303],"facilities":[293],"(42.5%).":[294],"Adjusted":[295],"odds":[296],"ratios":[297],"(aOR)":[298],"facility,":[304,307,359],"other":[305,357],"medical":[306,358],"or":[308,360],"hospice":[309],"differed":[310,378,384],"after":[314,387],"controlling":[315],"variables.":[320],"Compared":[321],"group,":[325],"Overall\u201d,":[328],"both":[329],"(aOR=2.76,":[333],"95%":[334,343],"CI":[335,344],"2.45,":[336],"3.12)":[337],"(aOR=4.91,":[342],"3.73,":[345],"6.47)":[346],"significantly":[348],"more":[349],"likely":[350],"SNF,":[356],"hospice.":[361],"CONCLUSIONS":[362],"There":[363],"distinct":[365],"inpatient":[370],"hospitalizations,":[372],"trajectories.":[381],"Discharge":[382],"location":[383],"adjusting":[388],"confounders.":[390],"While":[391],"results":[392],"current":[395],"not":[398],"predictive,":[399],"descriptive":[401],"suggest":[403],"potential":[404],"future":[405],"implications":[406],"throughput":[409]},"counts_by_year":[],"updated_date":"2026-11-09T13:22:03.289127","created_date":"2026-08-13T00:00:00"}