Research Appraisals

Journal of hospital medicine

Gender differences in secure chat and electronic health records use among hospital-based physicians

BACKGROUND: Digital messaging within electronic health records (EHRs) is central to inpatient communication. While intended to enhance efficiency, these tools may contribute to unequal digital workloads. OBJECTIVE: To evaluate gender-based differences in EHR and secure messaging use among hospital-based physicians. METHODS: Retrospective observational study at a single academic tertiary care hospital using EHR metadata from July 2023 to June 2024. Participants included a total of 205 internal medicine and medicine-pediatrics physicians (108 senior residents, 97 faculty) serving as primary clinicians on hospitalist shifts. Measures included daily number of messages sent/received, time spent in EHR and secure chat, and hours worked, stratified by gender and role. RESULTS: Physicians worked a median of 9.4 h/day, spending 40.7% of their time in the EHR and 6.3% in secure chat. Women and men work similar hours (9.5 vs. 9.3, p = .40) but women spent more time in the EHR (248 vs. 222 min/day; p < .001) and secure chat (38 vs. 34 min, p < .001) and exchanged more daily messages (62 vs. 53 sent; 56 vs. 48 received, both p < .001). Patterns were consistent across residents and faculty. Among faculty, gender differences persisted after a new scheduling model, which reduced overall work hours. CONCLUSIONS: Women physicians engaged more in digital communication than men, despite similar hours worked, and these differences persisted after a workflow change. These findings underscore the need for equity-informed strategies that both mitigate excess burden and recognize the potential value of proactive communication in hospital settings.