How much do EHRs contribute to physician burnout?

Many physicians feel stress at work due to interacting with their institution’s electronic health record (EHR), according to new findings published in JAMA Network Open. Burnout is a considerable problem for healthcare providers from many specialties, including radiology; reducing any burnout symptoms can make a direct impact on patient care.

“The adoption of the EHR has occurred alongside the dramatic and troubling rise in clinician stress and burnout,” wrote Philip J. Kroth, MD, MS, University of New Mexico in Albuquerque, and colleagues. “This association has fueled the debate over the extent to which EHRs are associated with the epidemic of clinician stress and burnout.”

Kroth et al. asked physician focus groups from three different institutions—one in California, one in New Mexico and one in Colorado—to identify aspects of EHR design and functionality “perceived as successful” and “associated with user stress, burnout or unintended physical symptoms.”

The design and use factors identified by the three focus groups were then worked into a survey sent out from Aug. 9, 2016, to July 7, 2017. A total of 282 physicians and advanced practice clinicians from those same three institutions completed the survey.

While 74.5% of respondents reported that they feel pressure related to filling out documents in a certain amount of time, 60.2% said they spent “moderately high or excessive time on the EHR at home.” Also, 50.4% or respondents said they “had insufficient personal time,” 76.2% said “productivity was overemphasized” at their institution and 50.7% said they had a chaotic or somewhat chaotic office environment.  

As far as burnout was concerned, 45% of respondents said they experienced specific burnout symptoms, and 41.5% said they were “moderately to definitely likely to leave their practices within two years.”

The most common concerns about EHR design listed by respondents were the significant amount of data entry required (86.9%), “long cut-and-pasted notes” (75.2%), inaccessible information from other institutions (73.1%), notes geared specifically toward billing (73.1%), interference with a work-life balance (63.1%) and posture (51.1%) or pain (47.5%) issues stemming from EHR use.

Overall, the authors found that these various design and use factors accounted for 12.5% of variance in measures of the respondents’ stress and 6.8% of variance in their stress.

“Stress and burnout associated with EHRs is prevalent and may be at least partly remediable at the local level,” the authors wrote. “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.”

The authors also addressed the “high” percentages of respondents who reported posture or pain issues from using the EHR.

“Ergonomics are rarely addressed in most clinical settings,” they wrote. “Clinicians often must work at several workstations, with different heights and seat structures. Collaboration with employee health groups skilled at ergonomics could potentially have a substantive effect on the health outcomes of our clinician workforce. This is an area ripe for further quality improvement studies.”