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

Abstract

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.

Telemedicine in an Adolescent and Young Adult Medicine Clinic: A Mixed Methods Study

“…While Zoom fatigue has been described and some studies have measured it among health care providers, little research has explored the phenomenon in patient populations or its impact on the quality of telemedicine visits. (17)(18)(19) This issue may be particularly relevant to younger populations who continue to engage in distance learning or in adults who telecommute.…”

Concurrent Rising of Dry Eye and Eye Strain Symptoms Among University Students During the COVID-19 Pandemic Era: A Cross-Sectional Study

“…Lastly, psychosocial factors and psychological variables were not considered in the present study, even though previous studies have related severe DES and DED symptoms to stress, anxiety, depression, and somatic disorders such as headache and insomnia. 28,29 However, this study contributes significantly to the literature despite the above limitations. We showed a rising concurrent correlation between DES and DED symptoms and first revealed that patients with higher digital eye strain symptoms are exposed to developing more severe dry eye disease.…”

“…Lastly, psychosocial factors and psychological variables were not considered in the present study, even though previous studies have related severe DES and DED symptoms to stress, anxiety, depression, and somatic disorders such as headache and insomnia. 28 , 29 …”

The Role of Human and Organizational Factors in the Pursuit of One Digital Health

“…Many of the surveyed papers studied HOFs using specific technologies including mental health consultation [20,21], online consultations [22,32], clinical decision support systems (CDSS) [23], electronic medication management systems [24], video consultation [25][26], aged care systems [27] and telemedicine [36]. The context of use for these systems included hospitals [23,[28][29][30][31][32][33][34], residential aged care homes [27], and community health facilities [35]. Eleven papers were review papers and described a range of technology, users, and processes [20-22, 26-27, 31, 37-41].…”

“…ODH is about broader health system goals such as coordination and communication, but system design often focuses on support for micro level tasks and outcomes such as efficiency. Broader system level outcomes as patient safety, enhancement of team-based care, and prevention of provider burnout will not be achieved unless we explicitly design and evaluate systems to support those goals [28,31]. Prevention of provider burnout and fatigue has to go beyond the design of technology at the individual level and must be evaluated with macro goals like the Quadruple Aim in order to support providers' well-being and to prevent workload burden, fatigue, and burnout [31].…”