Physician Burnout and the Electronic Health Record Leading Up to and During the First Year of COVID-19: Systematic Review (original) (raw)
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Electronic Health Records and Physician Burnout: A Scoping Review
Studies in health technology and informatics, 2021
This scoping review aims to identify the causes and consequences of physician burnout resulting from using Electronic Health Records (EHRs), as reported by current literature. We identified studies by searching PubMed, Wiley Online Library, and Google Scholar. Study selection and data extraction were conducted by three reviewers independently. Extracted data was then synthesized narratively. Out of 500 references retrieved, 30 studies met all eligibility criteria. We identified six main causes that lead to physician burnout related to the use of EHRs: EHRs' documentation and related tasks, EHRs' poor design, workload, overtime work, inbox alerts, and alert fatigue. We also identified the following consequences of physician burnout: low-quality care, behavioral issues, mental health complications, substance abuse, career dissatisfaction, costly turnover, and a decline in patient safety and satisfaction.
Association of Electronic Health Record Design and Use Factors With Clinician Stress and Burnout
JAMA Network Open
IMPORTANCE Many believe a major cause of the epidemic of clinician burnout is poorly designed electronic health records (EHRs). OBJECTIVES To determine which EHR design and use factors are associated with clinician stress and burnout and to identify other sources that contribute to this problem. DESIGN, SETTING, AND PARTICIPANTS This survey study of 282 ambulatory primary care and subspecialty clinicians from 3 institutions measured stress and burnout, opinions on EHR design and use factors, and helpful coping strategies. Linear and logistic regressions were used to estimate associations of work conditions with stress on a continuous scale and burnout as a binary outcome from an ordered categorical scale. The survey was conducted between August 2016 and July 2017, with data analyzed from January 2019 to May 2019. MAIN OUTCOMES AND MEASURES Clinician stress and burnout as measured with validated questions, the EHR design and use factors identified by clinicians as most associated with stress and burnout, and measures of clinician working conditions. RESULTS Of 640 clinicians, 282 (44.1%) responded. Of these, 241 (85.5%) were physicians, 160 (56.7%) were women, and 193 (68.4%) worked in primary care. The most prevalent concerns about EHR design and use were excessive data entry requirements (245 [86.9%]), long cut-and-pasted notes (212 [75.2%]), inaccessibility of information from multiple institutions (206 [73.1%]), notes geared toward billing (206 [73.1%]), interference with work-life balance (178 [63.1%]), and problems with posture (144 [51.1%]) and pain (134 [47.5%]) attributed to the use of EHRs. Overall, EHR design
JAMIA Open
This case report describes an initiative implemented to improve physicians’ experience with Electronic Health Records (EHRs), and is one of several strategies within our organization developed to reduce physician burnout attributed to the EHR. The EHR SWAT Team—a 10-member team—with interdisciplinary representation from clinical informatics, pharmacy informatics, health information management, clinical applications, and project management, is a direct feedback channel for all physicians to express their EHR challenges and have their requests reviewed, prioritized, and fixed in a timely manner. Through in-person divisional meetings, we gathered 118 requests, 36.4% of which were related to re-education and 17% of which were quick fixes. Popular requests included keyword search functionality, minimizing freezing, auto-faxing and auto-save. Our brief evaluation of 46 physicians demonstrated that physicians were satisfied with the initiative, with 61.3% physicians reporting that it incre...
Journal of the American Medical Informatics Association, 2021
Clinicians often attribute much of their burnout experience to use of the electronic health record, the adoption of which was greatly accelerated by the Health Information Technology for Economic and Clinical Health Act of 2009. That same year, AMIA’s Policy Meeting focused on possible unintended consequences associated with rapid implementation of electronic health records, generating 17 potential consequences and 15 recommendations to address them. At the 2020 annual meeting of the American College of Medical Informatics (ACMI), ACMI fellows participated in a modified Delphi process to assess the accuracy of the 2009 predictions and the response to the recommendations. Among the findings, the fellows concluded that the degree of clinician burnout and its contributing factors, such as increased documentation requirements, were significantly underestimated. Conversely, problems related to identify theft and fraud were overestimated. Only 3 of the 15 recommendations were adjudged mor...
The electronic elephant in the room: Physicians and the electronic health record
JAMIA Open
Objectives Determine the specific aspects of health information and communications technologies (HICT), including electronic health records (EHRs), most associated with physician burnout, and identify effective coping strategies. Materials and methods We performed a qualitative analysis of transcripts from 2 focus groups and a burnout assessment of ambulatory physicians—each at 3 different health care institutions with 3 different EHRs. Results Of the 41 clinicians, 71% were women, 98% were physicians, and 73% worked in primary care for an average of 11 years. Only 22% indicated sufficient time for documentation. Fifty-six percent noted “a great deal of stress” because of their job. Forty-two percent reported “poor” or “marginal” control over workload. Even though 90% reported EHR proficiency, 56% indicated EHR time at home was “excessive” or “moderately high.” Focus group themes included HICT “successes” where all patients’ information is accessible from multiple locations. HICT “s...
Physicians’ electronic health records use at home, job satisfaction, job stress and burnout
Journal of Hospital Administration, 2018
Objective: To determine how electronic health record (EHR) use at home impacts physician job satisfaction, job stress and burnout.Methods: This study looks at survey responses from 1,048 physicians in New York in 2016 to see how time spent on EHRs at home affected physician’s job satisfaction, job stress and burnout.Results: Accounting for demographic and practice values, physicians’ moderately high to excessive time spent on EHRs at home did not significantly affect job satisfaction but did significantly increase their odds of experiencing job stress by 50% and burnout by 46%. However, length and degree of documentation requirements and extension of work life into home by means of e-mail, completion of records and phone calls significantly correlated to decreased job satisfaction and increased job stress and likelihood of burnout.Conclusions: Although technology allows for physicians to work on electronic devices in various locations, healthcare administrators, policy makers and ph...
Healthcare, 2021
Healthcare providers’ burnout may potentially have a negative impact on patient care. The use of the electronic health record (EHR) increases the burden for healthcare providers (HCPs), particularly during the coronavirus disease-2019 (COVID-19) pandemic. This study assessed the stress and burnout related to the use of EHRs and health information technology (HIT) tools among HCPs during COVID-19 in Saudi Arabia. We used a self-developed survey tool. It consisted of five sections; demographics and professional data, experience using EHR, effects of EHR use, use of EHR and technology tools during COVID-19, and health and wellbeing. The survey link was emailed to a random sample of HCPs registered with a national scientific regulatory body. Univariate, bivariate, and multivariate analyses were performed to measure the association between burnout and study variables. A total of 182 participants completed the survey. 50.5% of participants reported a presence of HIT-related stress, and 40...
A Scoping Review of Health Information Technology in Clinician Burnout
Applied Clinical Informatics, 2021
Background Clinician burnout is a prevalent issue in healthcare, with detrimental implications in healthcare quality and medical costs due to errors. The inefficient use of health information technologies (HIT) is attributed to having a role in burnout. Objective This paper seeks to review the literature with the following two goals: (1) characterize and extract HIT trends in burnout studies over time, and (2) examine the evidence and synthesize themes of HIT's roles in burnout studies. Methods A scoping literature review was performed by following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines with two rounds of searches in PubMed, IEEE Xplore, ACM, and Google Scholar. The retrieved papers and their references were screened for eligibility by using developed inclusion and exclusion criteria. Data were extracted from included papers and summarized either statistically or qualitatively to demonstrate patterns. Results After narrowing do...
Mayo Clinic proceedings, 2016
To evaluate associations between the electronic environment, clerical burden, and burnout in US physicians. Physicians across all specialties in the United States were surveyed between August and October 2014. Physicians provided information regarding use of electronic health records (EHRs), computerized physician order entry (CPOE), and electronic patient portals. Burnout was measured using validated metrics. Of 6375 responding physicians in active practice, 5389 (84.5%) reported that they used EHRs. Of 5892 physicians who indicated that CPOE was relevant to their specialty, 4858 (82.5%) reported using CPOE. Physicians who used EHRs and CPOE had lower satisfaction with the amount of time spent on clerical tasks and higher rates of burnout on univariate analysis. On multivariable analysis, physicians who used EHRs (odds ratio [OR]=0.67; 95% CI, 0.57-0.79; P<.001) or CPOE (OR=0.72; 95% CI, 0.62-0.84; P<.001) were less likely to be satisfied with the amount of time spent on cler...
Frequency and Causes of Burnout in US Community Oncologists in the Era of Electronic Health Records
JCO Oncology Practice, 2020
BACKGROUND: Physician burnout, characterized by exhaustion of physical or emotional strength, cynicism, and lack of achievement, has become a worsening phenomenon in medicine, contributing to higher health care costs and patient/physician dissatisfaction. How burnout has affected hematologists and oncologists is not well studied. METHODS: US community oncologists/hematologists were queried via a Web-based survey from September-November 2018. Physicians were asked about frequency of burnout symptoms, drivers of work-related stress, and their perceptions on management of workload. RESULTS: Among the 163 physicians surveyed, 46% felt a substantial amount of stress at work. Most physicians felt emotionally (85%) and physically (87%) exhausted. A majority of physicians felt lethargic (67%), ineffective (64%), and/or detached (63%). In a typical workweek, 93% needed time beyond time allocated to clinical care to complete work responsibilities. Electronic health record (EHR) responsibiliti...