Physician Burnout and Timing of Electronic Health Record Use.

Mark A Micek,Brian Arndt,Elizabeth Trowbridge,Nancy Pandhi,Jennifer Lochner,Shannon M Dean,Emmanuel Sampene,Wen-Jan Tuan

doi:10.1055/s-0039-3401815

Abstract

Rates of burnout among physicians have been high in recent years. The Electronic Health Record (EHR) is implicated as a major cause of burnout. To determine the association between physician burnout and timing of EHR use in an academic internal medicine primary care practice. We conducted an observational cohort study using cross-sectional and retrospective data. Participants included primary care physicians in an academic outpatient general internal medicine practice. Burnout was measured with a single-item question via self-reported survey. EHR time was measured using retrospective automated data routinely captured within the institution's EHR. EHR time was separated into four categories: weekday workhours in-clinic time, weekday workhours out-of-clinic time, weekday afterhours time, and weekend/holiday afterhours time. Ordinal regression was used to determine the relationship between burnout and EHR time categories. EHR use during in-clinic sessions was related to burnout in both bivariate (OR=1.04, 95% CI 1.01, 1.06; p=0.007) and adjusted (OR=1.07, 95% CI 1.03, 1.1; p=0.001) analyses. No significant relationships were found between burnout and afterhours EHR use. In this small single-institution study, physician burnout was associated with higher levels of in-clinic EHR use but not afterhours EHR use. Improved understanding of the variability of in-clinic EHR use, and the EHR tasks that are particularly burdensome to physicians, could help lead to interventions that better integrate EHR demands with clinical care and potentially reduce burnout. Further studies including more participants from diverse clinical settings are needed to further understand the relationship between burnout and afterhours EHR use.

Highlights

Rates of burnout among physicians have been high in recent years
In this small single-institution study, physician burnout was associated with higher levels of in-clinic electronic health record (EHR) use but not after-hours EHR use
While it is difficult to determine the time spent in EHR on a typical weekday because of the variability in physicians’ schedules, we estimate that physicians spent approximately 299 minutes (5 hours) on the EHR during a day when they were in clinic for both morning and afternoon sessions

Summary

Introduction

Rates of burnout among physicians have been high in recent years. The electronic health record (EHR) is implicated as a major cause of burnout. Burnout among primary care physicians is a major problem in the United States. While many issues can contribute to physician dissatisfaction and burnout, the electronic health record (EHR) increasingly is implicated as a major source of dissatisfaction.[7,8,9,10] the EHR offers some benefits to practice, it pulls physicians’ time away from meaningful face-toface patient interactions toward data entry and asynchronous tasks, such as telephone/patient-portal care.[7] Recent studies confirm that the EHR occupies a large portion of physicians’ lives, both during and after traditional workhours. Another study found that primary care physicians spent almost 6 hours in the EHR per day, including 4.5 hours during, and 1.4 hours outside of, normal clinic hours.[12]

Objectives

Methods

Results

Discussion

Conclusion