Health Informatics

Our work in health informatics examines how people use electronic health records (EHRs), how we can use traces of EHR activity to study collaboration in healthcare.

Faculty: Adam Rule

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Electronic Health Record Metadata

Like other software, electronic health records (EHRs) keep a record of how people interact with them in software logs. These logs – known variously as audit logs, event logs, or EHR usage metadata – are a vital tool which researchers and administrators can use to better understand EHR use, clinical quality, and clinical workflows. In collaboration with researchers across the country, we have been cataloging how EHR metadata have been used in research and providing guidelines for their future use.


  • Rule, Adam, Edward R. Melnick, and Nate C. Apathy. “Using event logs to observe interactions with electronic health records: an updated scoping review shows increasing use of vendor-derived measures.” Journal of the American Medical Informatics Association 30.1 (2023): 144-154.
  • Sinsky, Christine A., Adam Rule, Genna Cohen, Brian G. Arndt, Tait D. Shanafelt, Christopher D. Sharp, Sally L. Baxter et al. “Metrics for assessing physician activity using electronic health record log data.” Journal of the American Medical Informatics Association 27, no. 4 (2020): 639-643.
  • Rule, Adam, Michael F. Chiang, and Michelle R. Hribar. “Using electronic health record audit logs to study clinical activity: a systematic review of aims, measures, and methods.” Journal of the American Medical Informatics Association 27.3 (2020): 480-490.

Electronic Health Record Use in Primary Care

Physicians and other members of primary care teams spend a tremendous amount of time interacting with electronic health records (EHR), time many of they would rather spend with patients. Using EHR metadata, we have been quantifying how EHR use varies by physician demographic and over time.


  • Micek, Mark A., et al. “Association of Primary Care Physicians’ Ambulatory Full-time Equivalencies With Time in the Electronic Health Record.” JAMA Network Open 6.6 (2023): e2320032-e2320032.
  • Rule, Adam, et al. “Gender Differences in Primary Care Physicians’ Electronic Health Record Use over Time: an Observational Study.” Journal of General Internal Medicine 38.6 (2023): 1570-1572.

Clinical Notes

After every patient encounter, medical providers write a clinical note summarizing the visit. Using electronic health record (EHR) metadata, we have been exploring how physicians and other members of the care team collaborate and use custom templates to write these notes.


  • Rule, Adam, and Michelle R. Hribar. “Frequent but fragmented: use of note templates to document outpatient visits at an academic health center.” Journal of the American Medical Informatics Association 29.1 (2022): 137-141.
  • Rule, Adam, et al. “Length and redundancy of outpatient progress notes across a decade at an academic medical center.” JAMA Network Open 4.7 (2021): e2115334-e2115334.