更少“睡衣时间”，更多患者时间：更好的互操作性如何减轻医生负担
Less Pajama Time, More Patient Time: How Better Interoperability Can Reduce Physician Burden
健康数据健康 IT互操作性更少“睡衣时间”，更多患者时间：更好的互操作性如何减轻医生负担Meghan Gabriel Vaishali Patel Chelsea Richwine Jordan Everson订阅订阅我们的新闻通讯随时了解我们的最新新闻和更新。
取消健康数据、健康 IT、互操作性2026年9月30日在ONC，我们推进数据流动性，并非将其视为一项抽象的技术项目。我们推进它，是为了让我们的卫生系统更好地服务于一线患者、家庭和临床医生。临床医生遇到的一项挑战，是与外部信息检索、事先授权和下班后文档记录相关的行政负担，常被称为“睡衣时间”。当所需信息难以在临床工作流程中访问、交换或使用时，许多此类负担便会出现。在我们最近发表的研究中，我们考察了超过8,400名家庭医生中这些负担的普遍程度和共同发生情况。超过四分之三的人至少经历了一种重大负担，15%的人经历了全部三种负担，即“三重负担”。截至2026年的新数据提供了一些令人鼓舞的进展迹象，同时也凸显了重大负担仍然持续存在的领域。
某些领域的行政负担正在下降
2024年至2026年间，家庭医生中重大睡衣时间（定义为每天三小时或以上）下降了6.2个百分点，从41%降至34%，而追踪外部健康信息的重大负担下降了5个百分点，从43%降至38%。然而，重大事先授权负担却朝相反方向变化，持续居高不下，并从2024年的54%上升到2026年的58%。
指标2024 2025 2026Δ（2024-2026）重大睡衣时间（每天3小时以上）41%37%*34%6.2个百分点重大事先授权负担54%57%*58%3.3个百分点重大外部信息负担43%40%*38%*5.0个百分点图1：2024—2026年家庭医生行政负担趋势注：与紧邻的上一年相比，P<0.05对于外部健康信息，重大负担从43%降至38%令人鼓舞，但仍有超过三分之一的家庭医生报告在追踪来自外部组织的信息方面存在重大负担。通过Trusted Exchange Framework and Common Agreement™（TEFCA®）和Fast Healthcare Interoperability Resources®（基于FHIR®的）交换，持续扩展全国范围的交换，为使所需信息在诊疗点更易获取提供了机会。
事先授权仍然是一个尤其持续存在的挑战。重大事先授权负担从2024年的54%上升到2026年的58%。HHS的努力，包括ONC的HTI-4规则和相应的CMS政策，旨在支持更简化、基于标准的电子事先授权工作流程，并减少导致临床医生负担的人工流程。
睡衣时间在三项指标中改善最大，从41%降至34%。与此同时，仍有三分之一的家庭医生报告每天在下班后文档记录上花费三小时或以上。持续的技术演进，包括利用人工智能支持文档记录和临床工作流程的新兴机会，可能为减轻这一负担提供更多途径。
经历“三重负担”的家庭医生减少
经历三重负担的家庭医生比例从2024年的15%下降到2025年的12%，并在2026年保持相对稳定，为12.2%。如果在全国范围内外推，这2.8个百分点的下降相当于2026年比2024年约减少3,000名经历全部三种重大负担的家庭医生。这可能使这些医生有更多时间治疗患者，而不是把大量时间花在行政工作上。即使有了这一改善，三重负担仍然是一项挑战，进一步的进展将需要技术、运营和工作流程改进相结合。
2024—2026年家庭医生中的三重负担2024—2026年家庭医生中的三重负担2024年该比例为15.0%，2025年为12.0%，2026年为12.2%。
20%15%10%5%0%15.0%12.0%*12.2%2024 2025 2026图2. 2024—2026年家庭医生中的三重负担注：与紧邻的上一年相比，P<0.05从减轻负担到“理想”互操作性另一项研究开发了一种测量方法，考察家庭医生在互操作性方面的真实世界体验，以构建“理想互操作性”的复合指标：
数据接收经常自动发生：
来自外部组织的临床信息无需手动搜索或检索即可流入EHR。
数据经常易于找到：
外部数据在EHR界面中标注清晰、放置合乎逻辑且可直观访问。
数据经常易于使用：
信息结构化、可核对，并能够纳入医嘱、用药清单、问题清单和临床决策。
图3. 药物的理想互操作性体验
医生为理想互操作性确定的最重要组成部分之一与药物信息有关。遗憾的是，尽管它对诊疗至关重要，只有13%的家庭医生体验过理想互操作性，即所有三个组成部分都经常且同时发生。如果我们拓宽定义，将这些组成部分有时以及经常发生也包括在内，那么药物数据的理想互操作性将增加三倍以上，从13%升至45%。
这一更广阔的视角捕捉到了部分进展，并凸显了从互操作性有时或偶尔奏效的系统，转向无缝运作以支持临床医生及其患者的系统的重要性。此类进展对于减少花在文书工作上的时间和增加照护患者的时间至关重要。
单一修复措施收效甚微
我们识别出的最大互操作性差距是数据可用性，这表明持续需要改进患者健康信息的交换。但仅有可用性还不够；成功的互操作性取决于易用性、标准和数据质量，以便信息能够被轻松找到、整合和使用。该研究的政策模拟发现，一次只针对互操作性的一个维度，带来的改善微乎其微，这强化了互操作性、文书工作和流程负担相互关联、必须共同解决的观点。
这些发现强化了为何改善连接性、简化行政工作流程，以及让信息更易于临床医生使用的工作必须并行推进。帮助我们识别进展正在何处发生，以及有针对性的举措可能在何处有助于减轻行政负担并改善互操作性。随着ONC和我们的联邦合作伙伴继续努力建设一个更加互联、以人为本的医疗保健系统，理解临床医生的真实世界体验并据此采取行动，仍将是衡量进展的重要标准。
Health Data Health IT Interoperability Less Pajama Time, More Patient Time: How Better Interoperability Can Reduce Physician Burden Meghan Gabriel Vaishali Patel Chelsea Richwine Jordan Everson Subscribe Subscribe to Our Newsletter Stay updated with our latest news and updates.
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Health Data, Health IT, Interoperability September 30, 2026 At ONC, we are not advancing data liquidity as an abstract technology project. We are advancing it so that our health system works better for patients, families, and clinicians on the front lines. One challenge encountered by clinicians is administrative burden related to external information retrieval, prior authorization, and after-hours documentation, often referred to as “pajama time.” Many of these burdens arise when needed information is difficult to access, exchange, or use in clinical workflows. In our recently published study, we examined the prevalence and co-occurrence of these burdens among more than 8,400 family physicians. More than three-quarters experienced at least one substantial burden, and 15% experienced all three, or the “triple burden.” New data through 2026 provide some encouraging signs of progress, while also highlighting areas where substantial burden persists.
Administrative Burden is Declining in Some Areas
Between 2024 and 2026, substantial pajama time (defined as three or more hours per day) declined by 6.2 percentage points among family physicians, from 41% to 34%, and substantial burden tracking down external health information declined by five percentage points, from 43% to 38%. However, substantial prior authorization burden moved in the opposite direction, remaining persistently high and increasing from 54% in 2024 to 58% in 2026.
Measure 2024 2025 2026 Δ (2024-2026) Substantial Pajama Time (3+ hours per day) 41% 37%* 34% 6.2 pp Substantial prior authorization burden 54% 57%* 58% 3.3 pp Substantial external-information burden 43% 40%* 38%* 5.0 pp Figure 1: Trends in Administrative Burden Among Family Physicians, 2024–2026 Note: P<0.05 compared with the immediately preceding year For external health information, the decline in substantial burden from 43% to 38% is encouraging, but more than one-third of family physicians still report substantial burden tracking down information from outside organizations. Continued expansion of nationwide exchange through Trusted Exchange Framework and Common Agreement™ (TEFCA®) and Fast Healthcare Interoperability Resources ® (FHIR®-based) exchange provides an opportunity to make needed information more readily available at the point of care.
Prior authorization remains a particularly persistent challenge. Substantial prior authorization burden increased from 54% in 2024 to 58% in 2026. HHS efforts, including ONC’s HTI-4 rule and corresponding CMS policies, are designed to support more streamlined, standards-based electronic prior authorization workflows and reduce the manual processes that contribute to clinician burden.
Pajama time showed the largest improvement of the three measures, declining from 41% to 34%. At the same time, one-third of family physicians still report spending three or more hours per day on after-hours documentation. Continued technology evolution, including emerging opportunities to use artificial intelligence to support documentation and clinical workflows, may offer additional avenues for reducing this burden.
Fewer Family Physicians are Experiencing the “Triple Burden”
The percentage of family physicians experiencing the triple burden declined from 15% in 2024 to 12% in 2025 and remained relatively stable at 12.2% in 2026. If we extrapolate nationally, this 2.8 percentage-point decline is equivalent to approximately 3,000 fewer family physicians experiencing all three substantial burdens in 2026 than in 2024. This could result in those physicians having more time to treat patients, rather than spending so much of their time on administrative work. Even with this improvement, the triple burden remains a challenge, and further progress will require a combination of technical, operational, and workflow improvements.
Triple Burden Among Family Physicians, 2024–2026
Triple Burden Among Family Physicians, 2024–2026 The percentage is 15.0 percent in 2024, 12.0 percent in 2025, and 12.2 percent in 2026.
20% 15% 10% 5% 0% 15.0% 12.0%* 12.2% 2024 2025 2026 Figure 2. Triple Burden Among Family Physicians, 2024-2026 Note: P<0.05 compared with the immediately preceding year From Reducing Burden to “Ideal” Interoperability Another study developed a measurement approach that examined family physicians’ real-world experience with interoperability to create a composite measure of “ideal interoperability”:
Automatic data receipt occurs often Clinical information from outside organizations flows into the EHR without manual search or retrieval.
Data are often easy to find:
External data are clearly labeled, logically placed, and intuitively accessible in the EHR interface.
Data are often easy to use:
The information is structured, reconcilable, and able to be incorporated into orders, medication lists, problem lists, and clinical decision-making.
Figure 3. Ideal Interoperability Experience for Medications
One of the more important components physicians identified for ideal interoperability is related to medication information. Unfortunately, despite it being critical for care, only 13% of family physicians experienced ideal interoperability, meaning all three components occurred often and simultaneously. If we broaden the definition to include when these components occur sometimes as well as often, ideal interoperability for medication data would increase more than three-fold, from 13% to 45%.
That broader lens captures partial progress and highlights the importance of moving from a system where interoperability sometimes or occasionally works, to one where it works seamlessly to support clinicians and their patients. Such progress is integral for reducing time spent on paperwork and increasing time caring for patients.
Single Fixes Don’t Move the Needle Much
The largest interoperability gap we identified was data availability, showing a continued need to improve the exchange of patient health information. But availability alone is not enough; successful interoperability depends on usability, standards, and data quality so that information can be easily found, integrated, and used. The study’s policy simulation found that targeting only one dimension of interoperability at a time produced minimal improvement, reinforcing that interoperability, paperwork, and process burdens are connected and must be tackled together.
These findings reinforce why efforts to improve connectivity, streamline administrative workflows, and make information easier for clinicians to use is important to advance in parallel. help us to identify where progress is occurring and where targeted initiatives may help reduce administrative burden and improve interoperability. As ONC and our federal partners continue working to build a more connected, person-centered health care system, understanding and acting upon clinicians’ real-world experiences will remain an important measure of progress.