Local Investment in Training Drives Electronic Health Record User Satisfaction

Longhurst, Christopher A.; Davis, T; Maneker, Amy; Eschenroeder, H C; Dunscombe, Rachel; Reynolds, G C S; Clay, Brian; Moran, Thomas J.; Graham, David; Dean, Shannon M.; Adler‐Milstein, Julia

doi:10.1055/s-0039-1688753

Cited by 62 publications

(60 citation statements)

References 14 publications

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“…It is also imperative to better understand the factors involved with high-intensity and intrusive EHR use, particularly during clinic sessions when physicians are required to do multiple computer-related tasks while seeing patients. Improved understanding of the dynamics of in-clinic EHR use, including which specific EHR tasks are particularly related to burnout, may lead to focused interventions at the organizational and individual level, such as improved EHR training, 25,26 the adoption of scribes, 23,24 or the reduction of waste in data entry and documentation processes. [31][32][33] These strategies may ultimately help promote better quality of care and a happier and more stable physician workforce.…”

Section: Resultsmentioning

confidence: 99%

“…This could lead to targeted physician-and organization-level interventions focused on improving EHR efficiency, offloading work from physicians, and better integrating computer-oriented tasks during face-to-face encounters. Indeed, physician satisfaction has been shown to improve with interventions that distribute EHR tasks to other members of the health care team, 23,24 enhance physicians' EHR efficiency through proficiency training, 25,26 and improve note documentation. 27 Our results did not show a consistently significant relationship between after-hours EHR work (often referred to as "pajama time") and burnout.…”

Section: Discussionmentioning

confidence: 99%

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Physician Burnout and Timing of Electronic Health Record Use

Micek

Arndt

Tuan³

et al. 2020

ACI Open

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Background Rates of burnout among physicians have been high in recent years. The electronic health record (EHR) is implicated as a major cause of burnout. Objective This article aimed to determine the association between physician burnout and timing of EHR use in an academic internal medicine primary care practice. Methods 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 work-hours in-clinic time, weekday work-hours out-of-clinic time, weekday afterhours time, and weekend/holiday after-hours time. Ordinal regression was used to determine the relationship between burnout and EHR time categories. Results EHR use during in-clinic sessions was related to burnout in both bivariate (odds ratio [OR] = 1.04, 95% confidence interval [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 after-hours EHR use. Conclusion In this small single-institution study, physician burnout was associated with higher levels of in-clinic EHR use but not after-hours 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 after-hours EHR use.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Physician Burnout and Timing of Electronic Health Record Use

Micek

Arndt

Tuan³

et al. 2020

ACI Open

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“…Fourth, survey respondents may conflate their EHR usability with the burdens of documentation due to regulatory, clerical, or administrative requirements or local implementation that manifest in the EHR (eg, individual proficiency). 12,36,37 Specifically, institutional interpretations and implementation of state or federal regulations could manifest in profound differences in physician documentation requirements that the physician perceives as a deficiency in his or her EHR. For example, some hospitals require password revalidation before e-prescribing although the physician is already signed into the EHR, while a neighboring hospital may not.…”

Section: Discussionmentioning

confidence: 99%

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

Melnick

Dyrbye

Sinsky

et al. 2020

Mayo Clinic Proceedings

287

211

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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% (n¼1250) 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 AE SD SUS score was 45.9AE21.9. 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. ª 2019 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/) n Mayo Clin Proc. 2020;95(3):476-487

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“…Building on the national experience and published literature around EHR optimization, [37][38][39] the following strategies were Conclusion Informatics-enabled QI interventions can promote patient-centeredness and face-to-face communication in high-volume outpatient ophthalmology encounters. By employing an array of interventions, time spent exclusively talking with the patient returned to levels equivalent to paper charts by 6 months after EHR implementation.…”

Section: Intervention Strategiesmentioning

confidence: 99%

Promoting Quality Face-to-Face Communication during Ophthalmology Encounters in the Electronic Health Record Era

et al. 2020

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Objective To evaluate informatics-enabled quality improvement (QI) strategies for promoting time spent on face-to-face communication between ophthalmologists and patients. Methods This prospective study involved deploying QI strategies during implementation of an enterprise-wide vendor electronic health record (EHR) in an outpatient academic ophthalmology department. Strategies included developing single sign-on capabilities, activating mobile- and tablet-based applications, EHR personalization training, creating novel workflows for team-based orders, and promoting problem-based charting to reduce documentation burden. Timing data were collected during 648 outpatient encounters. Outcomes included total time spent by the attending ophthalmologist on the patient, time spent on documentation, time spent on examination, and time spent talking with the patient. Metrics related to documentation efficiency, use of personalization features, use of team-based orders, and note length were also measured from the EHR efficiency portal and compared with averages for ophthalmologists nationwide using the same EHR. Results Time spent on exclusive face-to-face communication with patients initially decreased with EHR implementation (2.9 to 2.3 minutes, p = 0.005) but returned to the paper baseline by 6 months (2.8 minutes, p = 0.99). Observed participants outperformed national averages of ophthalmologists using the same vendor system on documentation time per appointment, number of customized note templates, number of customized order lists, utilization of team-based orders, note length, and time spent after-hours on EHR use. Conclusion Informatics-enabled QI interventions can promote patient-centeredness and face-to-face communication in high-volume outpatient ophthalmology encounters. By employing an array of interventions, time spent exclusively talking with the patient returned to levels equivalent to paper charts by 6 months after EHR implementation. This was achieved without requiring EHR redesign, use of scribes, or excessive after-hours work. Documentation efficiency can be achieved using interventions promoting personalization and team-based workflows. Given their efficacy in preserving face-to-face physician–patient interactions, these strategies may help alleviate risk of physician burnout.

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Local Investment in Training Drives Electronic Health Record User Satisfaction

Cited by 62 publications

References 14 publications

Physician Burnout and Timing of Electronic Health Record Use

Physician Burnout and Timing of Electronic Health Record Use

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

Promoting Quality Face-to-Face Communication during Ophthalmology Encounters in the Electronic Health Record Era

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