A systematic review of contributing factors of and solutions to electronic health record–related impacts on physician well-being

Nguyen, Oliver T.; Jenkins, Nyasia J; Khanna, Neel; Shah, Shivani; Gartland, Alexander J; Turner, Kea; Merlo, Lisa J.

doi:10.1093/jamia/ocaa339

Cited by 49 publications

(28 citation statements)

References 65 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…A shift to a culture of well-being with technology use requires the evaluation, implementation, and monitoring of individual, workplace, workflow, and institutional strategies ( Multimedia Appendix 4 [ 2 , 6 , 7 , 23 - 25 , 28 - 30 , 37 , 44 , 49 - 53 , 56 , 74 , 83 - 85 ]). If the link between technology and fatigue is poorly recognized, changes in workflow processes and policies may not be carried out until the provider’s well-being is already at risk owing to burnout [ 49 ].…”

Section: Resultsmentioning

confidence: 99%

Findings and Guidelines on Provider Technology, Fatigue, and Well-being: Scoping Review

Hilty¹,

Armstrong²,

Smout³

et al. 2022

J Med Internet Res

View full text Add to dashboard Cite

Background Video and other technologies are reshaping the delivery of health care, yet barriers related to workflow and possible provider fatigue suggest that a thorough evaluation is needed for quality and process improvement. Objective This scoping review explored the relationship among technology, fatigue, and health care to improve the conditions for providers. Methods A 6-stage scoping review of literature (from 10 databases) published from 2000 to 2020 that focused on technology, health care, and fatigue was conducted. Technologies included synchronous video, telephone, informatics systems, asynchronous wearable sensors, and mobile health devices for health care in 4 concept areas related to provider experience: behavioral, cognitive, emotional, and physical impact; workplace at the individual, clinic, hospital, and system or organizational levels; well-being, burnout, and stress; and perceptions regarding technology. Qualitative content, discourse, and framework analyses were used to thematically analyze data for developing a spectrum of health to risk of fatigue to manifestations of burnout. Results Of the 4221 potential literature references, 202 (4.79%) were duplicates, and our review of the titles and abstracts of 4019 (95.21%) found that 3837 (90.9%) were irrelevant. A full-text review of 182 studies revealed that 12 (6.6%) studies met all the criteria related to technology, health care, and fatigue, and these studied the behavioral, emotional, cognitive, and physical impact of workflow at the individual, hospital, and system or organizational levels. Video and electronic health record use has been associated with physical eye fatigue; neck pain; stress; tiredness; and behavioral impacts related to additional effort owing to barriers, trouble with engagement, emotional wear and tear and exhaustion, cognitive inattention, effort, expecting problems, multitasking and workload, and emotional experiences (eg, anger, irritability, stress, and concern about well-being). An additional 14 studies that evaluated behavioral, emotional, and cognitive impacts without focusing on fatigue found high user ratings on data quality, accuracy, and processing but low satisfaction with clerical tasks, the effort required in work, and interruptions costing time, resulting in more errors, stress, and frustration. Our qualitative analysis suggests a spectrum from health to risk and provides an outline of organizational approaches to human factors and technology in health care. Business, occupational health, human factors, and well-being literature have not studied technology fatigue and burnout; however, their findings help contextualize technology-based fatigue to suggest guidelines. Few studies were found to contextually evaluate differences according to health professions and practice contexts. Conclusions Health care systems need to evaluate the impact of technology in accordance with the Quadruple Aim to support providers’ well-being and prevent workload burden, fatigue, and burnout. Implementation and effectiveness approaches and a multilevel approach with objective measures for clinical, human factors, training, professional development, and administrative workflow are suggested. This requires institutional strategies and competencies to integrate health care quality, technology and well-being outcomes.

show abstract

Section: Resultsmentioning

confidence: 99%

Findings and Guidelines on Provider Technology, Fatigue, and Well-being: Scoping Review

Hilty¹,

Armstrong²,

Smout³

et al. 2022

J Med Internet Res

View full text Add to dashboard Cite

show abstract

“…Minimising negative impacts may help enhance nurse well-being, work satisfaction, engagement in using EMR, and retention. [2] , [26] .…”

Section: Discussionmentioning

confidence: 99%

Change in nurses’ psychosocial characteristics pre- and post-electronic medical record system implementation coinciding with the SARS-CoV-2 pandemic: pre- and post-cross-sectional surveys

Jedwab¹,

Hutchinson²,

Manias³

et al. 2022

International Journal of Medical Informatics

View full text Add to dashboard Cite

“…Finally, healthcare workforce and workflow redesign efforts are beginning to evaluate staffing and space to support a “post technology” ambulatory care model with changing—and often significant—workload demands and time constraints 23 . There is an urgent need to address the burnout many physicians, especially those in primary care, are feeling with the additional time requirements of EHR in-basket tasks and patient messages 24 . Patients expect prompt and often in-depth responses to electronic communication from providers, underscoring this need to address physician workload.…”

Section: Discussionmentioning

confidence: 99%

Factors Enhancing Trust in Electronic Communication Among Patients from an Internal Medicine Clinic: Qualitative Results of the RECEPT Study

2022

View full text Add to dashboard Cite

Background Electronic health records are now the norm in US healthcare. Bidirectional patient portals allow frequent communication between patients and their healthcare team. Many studies have examined the importance of patient engagement and trust between patients and their healthcare team, typically in the context of face-to-face interactions. Little is known about how patient trust and engagement are built or enhanced through electronic communications. COVID-19 provided a unique time in history for this novel exploration. Objective Our objective was to learn how patients experience trust formation through electronic communication (patient messaging and video visits) with their healthcare team. Design Our research was guided by grounded theory methodology. Qualitative interviews were conducted between February and December 2020 with patients or their caregivers from an internal medicine clinic in Colorado. Participants Fifty-one participants were recruited by age group and gender to represent the clinic’s adult ambulatory care demographics. Seven were patients’ caregivers who were purposefully recruited. Average age was 53 with an educated, middle class, and largely white predominance in our eventual sample. Approach Thirty-minute semi-structured interviews were conducted using an interview guide informed by a validated physician-patient trust scale. Interviews were conducted by telephone, recorded via Zoom, and transcribed. Results were analyzed and coded in ATLAS.ti utilizing the constant comparative method, with two coders. Key Results Patients experienced enhanced trust in their healthcare team through electronic communications. Interpersonal and system factors contributed to trust formation. Promptness of reply was the most salient factor in trust formation with a majority desiring same day response. Conclusions Patients now rely on electronic communication with their healthcare team. Opportunities exist to leverage this to improve health outcomes. Important research in expanded demographic groups, along with ambulatory healthcare redesign, will be necessary to optimize benefits of electronic communication with patients and meet patient expectations.

show abstract

A systematic review of contributing factors of and solutions to electronic health record–related impacts on physician well-being

Cited by 49 publications

References 65 publications

Findings and Guidelines on Provider Technology, Fatigue, and Well-being: Scoping Review

Findings and Guidelines on Provider Technology, Fatigue, and Well-being: Scoping Review

Change in nurses’ psychosocial characteristics pre- and post-electronic medical record system implementation coinciding with the SARS-CoV-2 pandemic: pre- and post-cross-sectional surveys

Factors Enhancing Trust in Electronic Communication Among Patients from an Internal Medicine Clinic: Qualitative Results of the RECEPT Study

Contact Info

Product

Resources

About