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1.
Mayo Clin Proc. 2019 Nov 12. pii: S0025-6196(19)30836-5. doi: 10.1016/j.mayocp.2019.09.024. [Epub ahead of print]

The Association Between Perceived Electronic Health Record Usability and Professional Burnout Among US Physicians.

Author information

1
Department of Emergency Medicine, Yale University School of Medicine, New Haven, CT. Electronic address: edward.melnick@yale.edu.
2
Department of Medicine, Mayo Clinic, Rochester, MN.
3
Professional Satisfaction and Practice Sustainability, American Medical Association, Chicago, IL.
4
Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, CA.
5
Department of Medicine, Mayo Clinic, Rochester, MN; Department of Health Sciences Research, Mayo Clinic, Rochester, MN.
6
Department of Medicine, Stanford School of Medicine, Palo Alto, CA.

Abstract

OBJECTIVE:

To describe and benchmark physician-perceived electronic health record (EHR) usability as defined by a standardized metric of technology usability and evaluate the association with professional burnout among physicians.

PARTICIPANTS AND METHODS:

This cross-sectional survey of US physicians from all specialty disciplines was conducted between October 12, 2017, and March 15, 2018, using the American Medical Association Physician Masterfile. Among the 30,456 invited physicians, 5197 (17.1%) completed surveys. A random 25% (n=1250) of respondents in the primary survey received a subsurvey evaluating EHR usability, and 870 (69.6%) completed it. EHR usability was assessed using the System Usability Scale (SUS; range 0-100). SUS scores were normalized to percentile rankings across more than 1300 previous studies from other industries. Burnout was measured using the Maslach Burnout Inventory.

RESULTS:

Mean ± SD SUS score was 45.9±21.9. A score of 45.9 is in the bottom 9% of scores across previous studies and categorized in the "not acceptable" range or with a grade of F. On multivariate analysis adjusting for age, sex, medical specialty, practice setting, hours worked, and number of nights on call weekly, physician-rated EHR usability was independently associated with the odds of burnout with each 1 point more favorable SUS score associated with a 3% lower odds of burnout (odds ratio, 0.97; 95% CI, 0.97-0.98; P<.001).

CONCLUSION:

The usability of current EHR systems received a grade of F by physician users when evaluated using a standardized metric of technology usability. A strong dose-response relationship between EHR usability and the odds of burnout was observed.

2.
JAMA Netw Open. 2019 Oct 2;2(10):e1912638. doi: 10.1001/jamanetworkopen.2019.12638.

An Exploration of Barriers, Facilitators, and Suggestions for Improving Electronic Health Record Inbox-Related Usability: A Qualitative Analysis.

Author information

1
Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas.
2
Department of Medicine, Baylor College of Medicine, Houston, Texas.
3
School of Biomedical Informatics, University of Texas Health Science Center at Houston, Houston.
4
Center for Healthcare Quality and Safety, University of Texas Health Science Center at Houston, Houston.

Abstract

Importance:

Managing messages in the electronic health record (EHR) inbox consumes substantial amounts of physician time. Certain factors associated with inbox management, such as poor usability and excessive and unnecessary inbox messages, have been associated with physician burnout. Additionally, inbox design, usability, and workflows are associated with physicians' situational awareness (ie, perception, comprehension, and projection of clinical status) and efficiency of processing EHR inbox messages. Understanding factors associated with inbox usability could improve future EHR inbox designs and workflows, thus reducing risk of burnout while improving patient safety.

Objective:

To determine barriers, facilitators, and suggestions associated with EHR inbox-related usability.

Design, Setting, and Participants:

This qualitative study included cognitive walkthroughs of EHR inbox management with 25 physicians (17 primary care physicians and 8 specialists) at 6 large health care organizations using 4 different EHR systems between May 6, 2015, and September 19, 2016. While processing EHR inbox messages, participants identified facilitators and barriers associated with EHR inbox situational awareness and processing efficiency and potential interventions to address such barriers. A qualitative analysis was performed on transcribed recordings using an inductive thematic approach with an 8-dimension sociotechnical model as a theoretical lens from May 6, 2015, to August 15, 2019.

Results:

The cognitive walkthroughs identified 60 barriers, 32 facilitators, and 28 suggestions for improving the EHR inbox. Emergent data fit within 5 major themes: message processing complexity, inbox interface design, cognitive load, team communication, and inbox message content. Within these themes, similar barriers were identified across sites, such as poor usability due the high numbers of clicks needed to accomplish actions. In certain instances, an identified facilitator at one site provided the exact solution needed to address a barrier identified at another site.

Conclusions and Relevance:

This qualitative study found that usability of the EHR inbox is often suboptimal and variable across sites, suggesting lack of shared best practices related to information management. Implementation of optimized design features and workflows will require EHR developers and health care organizations to collectively share this responsibility. Development of regional or national consortia to support collaborative sharing and implementation of EHR system best practices across EHR developers and health care organizations could also improve safety and efficiency and reduce physician burnout.

3.
Stud Health Technol Inform. 2019 Aug 21;264:1194-1198. doi: 10.3233/SHTI190415.

The Burden and Burnout in Documenting Patient Care: An Integrative Literature Review.

Author information

1
Department of Nursing, University of Massachusetts Boston, Boston, MA.
2
Department of Medicine, Brigham and Women's Hospital, Boston, MA.

Abstract

The implementation of the electronic health record (EHR) across the globe has increased significantly in the last decade. Motivations for this trend include patient safety, regulatory requirements, and healthcare cost containment. However, the impact of regulatory requirements and new EHRs on clinicians has increased the incidence of documentation burden and may lead to burnout syndrome. It is important to understand the extent of documentation burden and potential solutions such as EHR user-interface redesign and the use of scribes to assist healthcare providers across the world.

KEYWORDS:

Electronic Health Records; Healthcare Providers; Occupational Burnout

PMID:
31438114
DOI:
10.3233/SHTI190415
[Indexed for MEDLINE]
Icon for IOS Press
4.
PLoS One. 2019 Aug 16;14(8):e0221300. doi: 10.1371/journal.pone.0221300. eCollection 2019.

How are medical students using the Electronic Health Record (EHR)?: An analysis of EHR use on an inpatient medicine rotation.

Author information

1
Department of Internal Medicine, Division of Hospital Medicine, Stanford University School of Medicine, Stanford, California, United States of America.
2
Quantitative Sciences Unit, Stanford University School of Medicine, Stanford, California, United States of America.

Abstract

Physicians currently spend as much as half of their day in front of the computer. The Electronic Health Record (EHR) has been associated with declining bedside skills and physician burnout. Medical student EHR use has not been well studied or characterized. However, student responsibilities for EHR documentation will likely increase as the Centers for Medicare and Medicaid Services (CMS) most recent provisions now allow student notes for billing which will likely increase the role of medical student use of the EHR over time. To gain a better understanding of how medical students use the EHR at our institution, we retrospectively analyzed 6,692,994 EHR interactions from 49 third-year clerkship medical students and their supervising physicians assigned to the inpatient medicine ward rotation between June 25 2015 and June 24 2016 at a tertiary academic medical center. Medical students spent 4.42 hours (37%) of each day at the on the EHR and 35 minutes logging in from home. Improved understanding of student EHR-use and the effects on well-being warrants further attention, especially as EHR use increases with early trainees.

Conflict of interest statement

The authors have declared that no competing interests exist.

5.
JAMA Netw Open. 2019 Aug 2;2(8):e199609. doi: 10.1001/jamanetworkopen.2019.9609.

Association of Electronic Health Record Design and Use Factors With Clinician Stress and Burnout.

Author information

1
University of New Mexico, Albuquerque.
2
Stanford University, Palo Alto, California.
3
Centura Health, Westminster, Colorado.
4
University of Virginia, Charlottesville.
5
Minneapolis Medical Research Foundation, Minneapolis, Minnesota.
6
University of Utah, Salt Lake City.
7
Uniformed Services University of the Health Sciences, Bethesda, Maryland.
8
Hennepin County Medical Center, Minneapolis, Minnesota.

Abstract

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 and use factors accounted for 12.5% of variance in measures of stress and 6.8% of variance in measures of burnout. Work conditions, including EHR use and design factors, accounted for 58.1% of variance in stress; key work conditions were office atmospheres (β̂ = 1.26; P < .001), control of workload (for optimal control: β̂ = -7.86; P < .001), and physical symptoms attributed to EHR use (β̂ = 1.29; P < .001). Work conditions accounted for 36.2% of variance in burnout, where challenges included chaos (adjusted odds ratio, 1.39; 95% CI, 1.10-1.75; P = .006) and physical symptoms perceived to be from EHR use (adjusted odds ratio, 2.01; 95% CI, 1.48-2.74; P < .001). Coping strategies were associated with only 2.4% of the variability in stress and 1.7% of the variability in burnout.

Conclusions and Relevance:

Although EHR design and use factors are associated with clinician stress and burnout, other challenges, such as chaotic clinic atmospheres and workload control, explain considerably more of the variance in these adverse clinician outcomes.

6.
J Gen Intern Med. 2019 Sep;34(9):1825-1832. doi: 10.1007/s11606-019-05112-5. Epub 2019 Jul 10.

Practicing Clinicians' Recommendations to Reduce Burden from the Electronic Health Record Inbox: a Mixed-Methods Study.

Author information

1
Center for Innovations in Quality, Effectiveness and Safety (IQuESt) (152), Michael E. DeBakey Veterans Affairs Medical Center (MEDVAMC), 2002 Holcombe Boulevard, Houston, TX, 77030, USA. drmurphy@bcm.edu.
2
Department of Medicine, Baylor College of Medicine, Houston, TX, USA. drmurphy@bcm.edu.
3
Center for Innovations in Quality, Effectiveness and Safety (IQuESt) (152), Michael E. DeBakey Veterans Affairs Medical Center (MEDVAMC), 2002 Holcombe Boulevard, Houston, TX, 77030, USA.
4
Department of Medicine, Baylor College of Medicine, Houston, TX, USA.
5
University of Texas Health Science Center at Houston's School of Biomedical Informatics and the UT-Memorial Hermann Center for Healthcare Quality & Safety, Houston, TX, USA.

Abstract

BACKGROUND:

Workload from electronic health record (EHR) inbox notifications leads to information overload and contributes to job dissatisfaction and physician burnout. Better understanding of physicians' inbox requirements and workflows could optimize inbox designs, enhance efficiency, and reduce safety risks from information overload.

DESIGN:

We conducted a mixed-methods study to identify strategies to enhance EHR inbox design and workflow. First, we performed a secondary analysis of national survey data of all Department of Veterans Affairs (VA) primary care practitioners (PCP) to identify major themes in responses to a free-text question soliciting suggestions to improve EHR inbox design and workflows. We then conducted expert interviews of clinicians at five health care systems (1 VA and 4 non-VA settings using 4 different EHRs) to understand existing optimal strategies to improve efficiency and situational awareness related to EHR inbox use. Themes from survey data were cross-validated with interview findings.

RESULTS:

We analyzed responses from 2104 PCPs who completed the free-text inbox question (of 5001 PCPs who responded to survey) and used an inductive approach to identify five themes: (1) Inbox notification content should be actionable for patient care and relevant to recipient clinician, (2) Inboxes should reduce risk of losing messages, (3) Inbox functionality should be optimized to improve efficiency of processing notifications, (4) Team support should be leveraged to help with EHR inbox notification burden, (5) Sufficient time should be provided to all clinicians to process EHR inbox notifications. We subsequently interviewed 15 VA and non-VA clinicians and identified 11 unique strategies, each corresponding directly with one of these five themes.

CONCLUSION:

Feedback from practicing end-user clinicians provides robust evidence to improve content and design of the EHR inbox and related clinical workflows and organizational policies. Several strategies we identified could improve clinicians' EHR efficiency and satisfaction as well as empower them to work with their local administrators, health IT personnel, and EHR developers to improve these systems.

KEYWORDS:

burnout; efficiency; electronic health records; health information technology; medical informatics; situational awareness

PMID:
31292905
PMCID:
PMC6712240
[Available on 2020-09-01]
DOI:
10.1007/s11606-019-05112-5
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7.
AMIA Jt Summits Transl Sci Proc. 2019 May 6;2019:136-144. eCollection 2019.

Burnout and EHR use among academic primary care physicians with varied clinical workloads.

Author information

1
Oregon Health & Science University, Portland, Oregon, USA.

Abstract

Burnout is becoming increasingly prevalent among primary care physicians. Recent studies have attributed electronic health record (EHR) related tasks as a potential source of physician burnout. In this cross-sectional study, EHR use was compared to self-reported burnout for 107 faculty physicians at 10 university-affiliated primary care clinics. Physicians who self-reported burnout spent more time managing their inbox and in the EHR after hours. Burnout was associated with lower rates of same day chart closure, longer completion time for inbox messages, and more incomplete messages. Burnout, while related to overall workload, had a complex relationship with EHR use, which was influenced by but could not wholly explained by clinical workload. Our results suggest that burnout is less prevalent with less allocated clinical time, however, more research is necessary to identify the optimal balance between clinical duties and academic pursuits. Segmenting providers based on relative workload to determine variation within similar groups may help optimize EHR use.

8.
J Med Internet Res. 2019 Jun 3;21(6):e13313. doi: 10.2196/13313.

Unintended Consequences of Nationwide Electronic Health Record Adoption: Challenges and Opportunities in the Post-Meaningful Use Era.

Author information

1
Informatics Institute, University of Alabama at Birmingham, Birmingham, AL, United States.
2
Department of Biomedical Informatics, University of Utah, Salt Lake City, UT, United States.

Abstract

The US health system has recently achieved widespread adoption of electronic health record (EHR) systems, primarily driven by financial incentives provided by the Meaningful Use (MU) program. Although successful in promoting EHR adoption and use, the program, and other contributing factors, also produced important unintended consequences (UCs) with far-reaching implications for the US health system. Based on our own experiences from large health information technology (HIT) adoption projects and a collection of key studies in HIT evaluation, we discuss the most prominent UCs of MU: failed expectations, EHR market saturation, innovation vacuum, physician burnout, and data obfuscation. We identify challenges resulting from these UCs and provide recommendations for future research to empower the broader medical and informatics communities to realize the full potential of a now digitized health system. We believe that fixing these unanticipated effects will demand efforts from diverse players such as health care providers, administrators, HIT vendors, policy makers, informatics researchers, funding agencies, and outside developers; promotion of new business models; collaboration between academic medical centers and informatics research departments; and improved methods for evaluations of HIT.

KEYWORDS:

adoption; meaningful use; medical informatics applications

9.
JAMIA Open. 2018 Jul;1(1):49-56. doi: 10.1093/jamiaopen/ooy016. Epub 2018 Jun 11.

The electronic elephant in the room: Physicians and the electronic health record.

Author information

1
Health Sciences Library and Informatics Center, University of New Mexico Health Sciences Center, Albuquerque, New Mexico, USA.
2
Department of Internal Medicine, University of New Mexico School of Medicine, Albuquerque, New Mexico, USA.
3
Department of Medicine, Stanford University School of Medicine, Stanford University, Palo Alto, California, USA.
4
Department of Family Medicine, Centura Health, Westminster, Colorado, USA.
5
Project for Pride in Living, Minneapolis, Minnesota, USA.
6
Department of Medicine, University of Virginia, Charlottesville, Virginia, USA.
7
Minneapolis Medical Research Foundation, Minneapolis, Minnesota, USA and.
8
Department of Medicine, Hennepin County Medical Center, Minneapolis, Minnesota, USA.

Abstract

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 "stressors" included inefficient user interfaces, unpredictable system response times, poor interoperability between systems and excessive data entry. "Adverse outcomes" included ergonomic problems (eg, eye strain and hand, wrist, and back pain) and decreased attractiveness of primary care. Suggested "organizational changes" included EHR training, improved HICT usability, and scribes. "Personal/resilience" strategies focused on self-care (eg, exercise, maintaining work-life boundaries, and positive thinking).

Discussion and conclusion:

HICT use, while beneficial in many ways for patients and providers, has also increased the burden of ambulatory practice with personal and professional consequences. HICT and clinic architectural and process redesign are likely necessary to make significant overall improvements.

KEYWORDS:

electronic health records; health manpower; medical informatics; professional burnout

Conflict of interest statement

Conflict of interest statement. None declared.

10.
Pediatrics. 2019 May;143(5). pii: e20182803. doi: 10.1542/peds.2018-2803.

Health Care Use Over 3 Years After Adolescent SBIRT.

Author information

1
Division of Research, Kaiser Permanente Northern California, Oakland, California; and stacy.a.sterling@kp.org.
2
Division of Research, Kaiser Permanente Northern California, Oakland, California; and.
3
The Permanente Medical Group, Oakland, California.

Abstract

BACKGROUND:

Most studies on adolescent screening, brief intervention, and referral to treatment (SBIRT) have examined substance use outcomes. However, it may also impact service use and comorbidity-an understudied topic. We address this gap by examining effects of SBIRT on health care use and comorbidities.

METHODS:

In a randomized trial sample, we assessed 3 SBIRT care modalities: (1) pediatrician-delivered, (2) behavioral clinician-delivered, and (3) usual. Medical comorbidity and health care use were compared between a brief-intervention group with access to SBIRT for behavioral health (combined pediatrician and behavioral clinician arms) and a group without (usual care) over 1 and 3 years.

RESULTS:

Among a sample of eligible adolescents (n = 1871), the SBIRT group had fewer psychiatry visits at 1 year (incidence rate ratio [iRR] = 0.76; P = .05) and 3 years (iRR = 0.65; P < .05). Total outpatient visits did not differ in year 1. The SBIRT group was less likely to have mental health diagnoses (odds ratio [OR] = 0.69; 95% confidence interval [CI] = 0.48-1.01) or chronic conditions (OR = 0.66; 95% CI = 0.45-0.98) at 1 year compared with those in usual care. At 3 years, the SBIRT group had fewer total outpatient visits (iRR = 0.85; P < .05) and was less likely to have substance use diagnoses (OR = 0.64; 95% CI = 0.45-0.91) and more likely to have substance use treatment visits (iRR = 2.04; P < .01).

CONCLUSIONS:

Providing SBIRT in pediatric primary care may improve health care use and health, mental health, and substance use outcomes. We recommend further exploring the effects of SBIRT on these outcomes.

PMID:
31018988
PMCID:
PMC6564060
[Available on 2020-05-01]
DOI:
10.1542/peds.2018-2803
[Indexed for MEDLINE]
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11.
Nurs Res. 2019 Sep/Oct;68(5):339-347. doi: 10.1097/NNR.0000000000000357.

Demographics, Psychological Distress, and Pain From Pressure Injury.

Author information

1
Junglyun Kim, PhD, RN, is Post-Doctoral Associate, University of Florida College of Nursing, Gainesville. Debra Lyon, PhD, RN, FAAN, is Professor and Executive Associate Dean/Thomas M. and Irene B. Kirbo Endowed Chair, University of Florida College of Nursing, Gainesville. Michael T. Weaver, PhD, RN, FAAN, is Professor and Associate Dean for Research and Scholarship, University of Florida College of Nursing, Gainesville. Gail Keenan, PhD, RN, FAAN, is Professor, Annabel Davis Jenks Endowed Professor for Teaching and Research in Clinical Nursing Excellence, and Chair, Department of Family, Community and Health System Science, University of Florida College of Nursing, Gainesville. Joyce Stechmiller, PhD, APRN, FAAN, is Associate Professor, University of Florida College of Nursing, Gainesville.

Abstract

BACKGROUND:

There is a knowledge gap regarding factors that influence the intensity of pain associated with pressure injuries.

OBJECTIVES:

We examined the influence of age, gender, race, and comorbidity on the relationships between pressure injuries, psychological distress, and pain intensity in hospitalized adults.

METHODS:

This study was a cross-sectional, retrospective secondary analysis using data from a regional acute hospital's electronic health records from 2013 to 2016. A sample of 454 cases met the inclusion criteria and were analyzed using path analysis.

RESULTS:

The hypothesized model (Model A) and two alternative models (Models B and C) were tested and demonstrated adequate model fit. All tested models demonstrated statistically significant independent direct effects of age on the severity of pressure injury (p < .001) and pain intensity (p = .001), as well as independent direct effects of gender (p ≤ .005), race (p < .001), and comorbidity (p = .001) on psychological distress.

DISCUSSION:

Pain management for individuals with pressure injuries should include not only the treatment of wounds but also the individual characteristics of the patient such as demographics, comorbidity, and psychological status that may affect pain. Given the limitations of secondary analyses, further studies are suggested to validate these findings.

PMID:
30829837
DOI:
10.1097/NNR.0000000000000357
[Indexed for MEDLINE]
Icon for Wolters Kluwer
12.
Congenit Heart Dis. 2019 May;14(3):356-361. doi: 10.1111/chd.12745. Epub 2019 Mar 1.

Electronic health record associated stress: A survey study of adult congenital heart disease specialists.

Author information

1
Congenital Heart Center, Spectrum Health Helen DeVos Children's Hospital, Grand Rapids, Michigan.
2
Spectrum Health Office of Research, Grand Rapids, Michigan.
3
College of Human Medicine, Michigan State University, Grand Rapids, Michigan.

Abstract

BACKGROUND:

Physician burnout has many undesirable consequences, including negative impact on patient care delivery and physician career satisfaction. Electronic health records (EHRs) may exacerbate burnout by increasing physician workload.

OBJECTIVE:

To determine burnout in adult congenital heart disease (ACHD) specialists by assessing stress associated with EHRs.

DESIGN:

Electronic survey study of ACHD providers.

SETTING:

Canada and United States.

PARTICIPANTS:

Three hundred eighty-three ACHD specialists listed on the Adult Congenital Heart Association directory between February and April 2017.

OUTCOME MEASURES:

Burnout was measured using the Maslach Burnout Inventory (MBI) to understand factors contributing to work life and EHR satisfaction. Chi-square and Wilcoxon Rank Sum tests were used for statistical analysis.

RESULTS:

Of the 383 invited participants, 110 (28.7%) completed surveys with the majority (n = 88, 80.7%) reporting from an academic medical center. Burnout was defined as high scores on the emotional exhaustion and/or depersonalization MBI subscales. When comparing the 40% (n = 44) that met criteria for burnout with those that did not, there was strong disagreement that a reasonable amount of time is spent on clerical tasks related to direct (P = .0043) or indirect (P = .0004) patient care. There was strong disagreement that EHRs increased efficiency (P = .006) or the patient portal improved patient care (P = .0215). Finally, physicians who met criteria for burnout had lower personal accomplishment scores (P = .0355).

CONCLUSIONS:

Our results suggest time spent on EHRs creates clerical burden exacerbating ACHD physician burnout. The high levels of emotional exhaustion may decrease quality of ACHD care by directing focus away from physician-patient interaction. Health care systems must develop best practice for EHR design and implementation to optimize patient advocacy and care, and decrease physician burnout.

KEYWORDS:

adult congenital heart disease; electronic health record; patient care; physician burnout; stress; workload

PMID:
30825270
DOI:
10.1111/chd.12745
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13.
Mayo Clin Proc. 2019 May;94(5):793-802. doi: 10.1016/j.mayocp.2018.08.036. Epub 2019 Feb 26.

Optimization Sprints: Improving Clinician Satisfaction and Teamwork by Rapidly Reducing Electronic Health Record Burden.

Author information

1
Division of General Medicine, University of Colorado School of Medicine, Aurora.
2
UCHealth Medical Group, Loveland, CO.
3
UCHealth Information Technology, Aurora, CO.
4
Division of General Medicine, University of Colorado School of Medicine, Aurora. Electronic address: ct.lin@ucdenver.edu.

Abstract

OBJECTIVE:

To evaluate a novel clinic-focused Sprint process (an intensive team-based intervention) to optimize electronic health record (EHR) efficiency.

METHODS:

An 11-member team including 1 project manager, 1 physician informaticist, 1 nurse informaticist, 4 EHR analysts, and 4 trainers worked in conjunction with clinic leaders to conduct on-site EHR and workflow optimization for 2 weeks. The Sprint intervention included clinician and staff EHR training, building specialty-specific EHR tools, and redesigning teamwork. We used Agile project management principles to prioritize and track optimization requests. We surveyed clinicians about EHR burden, satisfaction with EHR, teamwork, and burnout 60 days before and 2 weeks after Sprint. We describe the curriculum, pre-Sprint planning, survey instruments, daily schedule, and strategies for clinician engagement.

RESULTS:

We report the results of Sprint in 6 clinics. With the use of the Net Promoter Score, clinician satisfaction with the EHR increased from -15 to +12 (-100 [worst] to +100 [best]). The Net Promoter Score for Sprint was +52. Perceptions of "We provide excellent care with the EHR," "Our clinic's use of the EHR has improved," and "Time spent charting" all improved. We report clinician satisfaction with specific Sprint activities. The percentage of clinicians endorsing burnout was 39% (47/119) before and 34% (37/107) after the intervention. Response rates to the survey questions were 47% (97/205) to 61% (89/145).

CONCLUSION:

The EHR optimization Sprint is highly recommended by clinicians and improves teamwork and satisfaction with the EHR. Key members of the Sprint team as well as effective local clinic leaders are crucial to success.

Comment in

PMID:
30824281
DOI:
10.1016/j.mayocp.2018.08.036
[Indexed for MEDLINE]
Free full text
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14.
JAMA. 2019 Feb 19;321(7):635-636. doi: 10.1001/jama.2019.0268.

Medical Scribes, Productivity, and Satisfaction.

Author information

1
Policy analyst with the Boston University School of Public Health.
2
Director, Partnered Evidence-based Policy Resource Center, Veterans Health Administration.
PMID:
30778589
DOI:
10.1001/jama.2019.0268
[Indexed for MEDLINE]
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15.
Ann Intern Med. 2019 Feb 5;170(3):216-217. doi: 10.7326/L18-0604.

Physician Burnout in the Electronic Health Record Era.

Author information

1
Stanford University School of Medicine, Stanford, California (N.L.D.).
2
Brigham and Women's Hospital, Harvard Medical School, and Harvard School of Public Health, Boston, Massachusetts (D.W.B.).
3
University of California, San Diego, School of Medicine, San Diego, California (C.A.L.).
PMID:
30716744
DOI:
10.7326/L18-0604
[Indexed for MEDLINE]
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16.
17.
Ann Intern Med. 2019 Feb 5;170(3):216. doi: 10.7326/L18-0601.

Physician Burnout in the Electronic Health Record Era.

Author information

1
Unity Sleep Disorders Center, Rochester Regional Health, Rochester, New York (M.K.).
PMID:
30716742
DOI:
10.7326/L18-0601
[Indexed for MEDLINE]
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18.
WMJ. 2018 Dec;117(5):194-200.

Physician Burnout in Wisconsin: An Alarming Trend Affecting Physician Wellness.

Author information

1
Wisconsin Medical Society, Madison, Wisconsin, anne.hauer@wismed.org.
2
Wisconsin Medical Society, Madison, Wisconsin.

Abstract

Wisconsin physicians are experiencing burnout at levels that surpass national benchmarks. The Wisconsin Medical Society (Society), in conjunction with the American Medical Association (AMA), conducted a survey of 1,165 Wisconsin physicians to assess burnout and its contributing factors. The results indicate that primary causes of physician burnout include utilization and interactions with electronic health records (EHR), lack of a supportive practice environment, the loss of autonomy, and poor work/life balance. Addressing physician burnout in Wisconsin calls for significant efforts by all relevant stakeholders, including insurers, government entities, health care systems and their executive leadership, and physicians themselves, and will require improving physician interactions with the EHR, increasing the physician role in administrative decision-making, and maintaining the focus of health care on the patient. To lessen the impact of the key factors that lead to physician burnout, the Society plans to convene stakeholders to improve EHR functionality, develop and encourage physician leadership opportunities, create a Center for Physician Empowerment to unite stakeholders to lead systemic change through collective education and action, and pursue legislation to establish a Physician Health Program through the state government structure.

PMID:
30674095
[Indexed for MEDLINE]
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19.
Am J Med Qual. 2019 Jul/Aug;34(4):416. doi: 10.1177/1062860618824015. Epub 2019 Jan 13.

Electronic Health Record and Physician Burnout.

20.
J Nucl Cardiol. 2018 Dec;25(6):1887-1889. doi: 10.1007/s12350-018-01474-1. Epub 2018 Oct 24.

A resolution for the new year: Responding to a call to organize against burnout crisis.

Author information

1
Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham, BDB 201, 1808 7th Avenue South, Birmingham, AL, 35294, USA. sprejean@uabmc.edu.
2
Department of Medicine, Center for Palliative and Supportive Care, University of Alabama at Birmingham, Birmingham, AL, USA.
3
Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham, BDB 201, 1808 7th Avenue South, Birmingham, AL, 35294, USA.
PMID:
30357581
DOI:
10.1007/s12350-018-01474-1
[Indexed for MEDLINE]
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