Electronic health records improve communication and access to patient data, but stress associated with using them can lead to doctor burnout, research suggests.

The stress comes from having too little time for documentation, time spent at home managing records, and EHR user interfaces that aren’t intuitive, a new study shows.

“You don’t want your doctor to be burned out or frustrated by the technology that stands between you and them,” says Rebekah Gardner, an associate professor of medicine at Brown University’s Warren Alpert Medical School and lead author of the paper in the Journal of the American Medical Informatics Association.

“In this paper, we show that EHR stress is associated with burnout, even after controlling for a lot of different demographic and practice characteristics. Quantitatively, physicians who have identified these stressors are more likely to be burned out than physicians who haven’t.”

Prior studies have looked into the factors that contribute to burnout in health care, Gardner says. Besides health information technology, these include chaotic work environments, productivity pressures, lack of autonomy, and a misalignment between the doctors’ values and the values they perceive the leaders of their organizations hold.

Earlier research has also show that burned-out doctors’ patients experience more errors and unnecessary tests.

The Rhode Island Department of Health surveys practicing physicians in Rhode Island every two years about how they use health information technology. In 2017, the research team included questions about health information technology-related stress and specifically EHR-related stress.

It’s ‘homework’

Of the almost 4,200 practicing physicians in the state, 43 percent responded, and the respondents were representative of the overall population. Almost all of the doctors used EHRs (91 percent) and of these, 70 percent reported at least one measure of EHR-related stress.

“It’s a signal to health care organizations that if they’re going to ‘fix’ burnout, one solution is not going to work for all physicians.”

Doctors say EHRs add to the frustration of their day because they spend moderate to excessive amounts of time on EHRs while at home and have insufficient time for documentation while at work.

Physicians with insufficient time had 2.8 times the odds of burnout symptoms compared to doctors without that pressure. The other two measures had roughly twice the odds of burnout symptoms.

Further, EHR-related stress depends on physician specialty.

More than a third of primary care physicians reported all three measures of EHR-related stress—including general internists (39.5 percent), family medicine physicians (37 percent), and pediatricians (33.6 percent). Many dermatologists (36.4 percent) also reported all three measures of EHR-related stress.

On the other hand, less than 10 percent of anesthesiologists, radiologists, and hospital medicine specialists reported all three measures of EHR-related stress.

Work chaos

While family medicine physicians (35.7 percent) and dermatologists (34.6 percent) reported the highest levels of burnout, in keeping with their high levels of EHR-related stress, hospital medicine specialists came in third at 30.8 percent. Other factors, such as a chaotic work environment, probably contribute to their rates of burnout, Gardner says.

“To me, it’s a signal to health care organizations that if they’re going to ‘fix’ burnout, one solution is not going to work for all physicians in their organization,” she says. “They need to look at the physicians by specialty and make sure that if they are looking for a technology-related solution, then that’s really the problem in their group.”

To deal with the stress, health care administrators could streamline documentation expectations or adopt policies where work-related email and EHR access is discouraged during vacation, Gardner says.

Since the survey wasn’t anonymous and the RIDOH is responsible for licensing physicians in the state, the doctors likely under-reported their levels of burnout and stress, Gardner says, but she believes the findings are still valid and significant.

Source: Brown University

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