Physician Burnout in the Electronic Health Record Era: Are We Ignoring the Real Cause?

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

“…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.…”

“…[4][5][6] Physicians now spend 1 to 2 hours on EHRs and deskwork for every hour spent in direct face-to-face contact with patients, as well as an additional 1 to 2 hours of personal time on EHR-related activities daily outside of office hours. [7][8][9] Although time spent with the EHR has been attributed to the clerical burden of current documentation requirements, [10][11][12] poor EHR usability has been found to be a contributor to physician dissatisfaction, and many have hypothesized a direct relationship between EHR usability and physician burnout. 5,10,[13][14][15][16] Usability is "the extent to which a product can be used by specified users to achieve specified goals with effectiveness, efficiency and satisfaction in a specified context of use."…”

Physician Burnout: Causes, Consequences, and (?) Cures

“…The EHR was created almost 10 years ago (an eon in computer time) to satisfy the requirements of hospitals and insurers rather than physicians. 2,11 There was no associated nationwide directory or regulatory infrastructure. 13 In addition, the EHR has not "kept pace with technology widely used to track, synthesize, and visualize information in many other domains of modern life."…”

“…13 Others argue, however, that the time has come for a total rethinking of the EHR, beginning with the underlying principles of patient care rather than with compliance and finances. 2 The creation of a new physician-and patient-centered EHR would be a great improvement. But would the government, the insurers, and the medical community be willing to admit that the first attempt was a failure and simply write off the hundreds of millions of dollars spent on it?…”

The Reply

“…Recent work by Downing et al noted not only that physicians spend much more time with their computer screen than with their patients, but that EPIC notes in the US were four times the length of notes in other countries. 2 Some of that is government and payer mandates, some is a product of our litigious society, but some must be owned by our physician community.…”