EHR design and use do contribute to physician burnout, but health systems should also focus on workload control and atmosphere to combat this adverse trend.
While many believe that poor EHR design and use are major causes of physician burnout, recent research indicates that other challenges, including office atmosphere, control of workload, and work-life balance deserve equal attention from designers and clinical leaders.
In a study published in JAMA Network Open, researchers set out to determine the extent to which EHRs are associated with clinician stress and burnout, noting that the rise of the EHR has led to significant changes in providers’ daily workflows.
“The introduction of EHRs has resulted in shifting many clerical tasks to clinicians (eg, billing, coding, and quality control) as well as creating new tasks to be performed during clinical encounters (e.g., data entry, computerized decision support, computerized order entry, and electronic prescribing),” researchers said. “These new tasks have increased the cognitive and physical load on the clinician in many ways.”
Researchers surveyed 282 ambulatory primary care and subspecialty clinicians from three institutions, measuring stress and burnout levels, opinions on EHR use and design factors, and non-EHR factors associated with burnout.
The results showed that 45 percent of participants described symptoms of burnout, and most reported stressful work conditions. Just under 75 percent reported time pressure for documentation, and 60.2 percent said they spent moderately or excessively high amounts of time on the EHR at home.
A little more than half (50.4 percent) of clinicians feel they have insufficient personal time, and just 33.7 percent said their organizations prioritize work-life balance.
The survey also showed that the EHR factors most significantly associated with burnout were information overload, slow system response times, excessive data entry, inability to quickly navigate the system, note bloat, interference with the patient-clinician relationship, and notes geared toward billing.
All the design and use factors collectively accounted for 12.5 percent and 6.8 percent of the variance in stress and burnout, researchers found. Factors not related to EHRs associated with high levels of stress and burnout were office atmosphere, control of workload, time for personal and family life, time for documentation at work, value alignment with leaders, professional and personal life balance, physical symptoms attributed to EHR use, and hours worked per week.
These variables accounted for 58.1 percent of variance in clinician-reported stress, and 36.2 percent of variance in burnout.
These results show that while the EHR does contribute to physician stress, other sources of burnout aside from the EHR need to be addressed to reduce burnout. Factors associated with the EHR should be addressed by local and higher-level leaders, the team noted.
“Many of the identified EHR design and use factors may be remediable through a combination of improvements by EHR vendors, local improvements by information technology personnel, and training of clinicians in the clinical environment,” researchers said.
“However, some of the identified factors may require higher-level actions on the part of clinic or governmental policy makers, for example, by allowing notes to be more geared toward clinical care than billing practices.”
The researchers noted that the study had some limitations, including the fact that it used self-reported metrics, which could be subject to bias. Additionally, because respondents came from only three institutions, the results may not be generalizable.
Despite these limitations, the results demonstrate the role non-EHR factors play in physician stress and burnout, the researchers stated.
“The issues identified in our list of EHR-associated challenges may provide designers, government regulators, and clinical leaders with targets for improvement of EHR design. Other work conditions are associated with stress and burnout in clinicians and deserve equal attention,” researchers concluded.
Date: August 26, 2019