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6 EHR Usability Pitfalls, Challenges Leading to Clinician Burnout

Total EHR time, clinician age, and EHR documentation were some of the top EHR usability factors that lead to clinician burnout.

Multiple EHR usability factors lead to clinician burnout, highlighted by total EHR time, after-hours EHR time, and EHR documentation time, according to a study published in the Journal of the American Medical Informatics Association (JAMIA).

According to the study authors, clinician burnout impacts up to 80.5 percent of clinicians and an average of 44 percent of clinicians experience burnout. Clinician burnout also costs health systems roughly $250,000 to $1 million per clinician who quits due to burnout or job dissatisfaction.

The research team evaluated over 7,000 articles over six databases and found 35 articles that fit their preferred criteria. The researchers dissected the articles to better understand clinician EHR use and its impact on clinician well-being.

The researchers found total EHR time, after-hours EHR time, on-site EHR support, perceived EHR usability, in-basket burden, and documentation burden as the top predictors of clinician well-being and burnout.

Practice setting

The research team found clinicians who work in hospitals are more likely to experience clinician burnout, compared to those who work in an office-based practice. Private group practices and hospital group practices were associated with increased EHR productivity. However, larger healthcare organizations had increased EHR-related burnout and lower EHR productivity.

Clinician age

Older clinicians had lower EHR usability scores, lower perceived EHR use, lower EHR productivity, and lower overall EHR satisfaction. But there was no connection between individuals who utilize the EHR at home and the utilization of EHRs in patient rooms.

Medical specialty

The degree of burnout varied across medical specialties. One study reported specialists received fewer in-basket messages than generalists. A second study found inconsistencies in EHR usability scores between specialties. For example, general internal medicine physicians rated EHR usability higher than family medicine and general surgery physicians.

Perceptions of EHR usability

A well-organized EHR interface and suitable EHR alerts were associated with increased EHR usability and lower frustration levels. Increased intuitiveness also led to lower levels of clinician burnout.

“Higher usability scores and ease of EHR use were associated with improved perceptions of EHR remote access and computer use as well as lower reported burnout, emotional exhaustion, and depersonalization scores,” wrote the study authors. “Non–user-friendly EHRs were associated with burnout. Perceptions that the EHR is cumbersome were associated with higher frustration levels.”

EHR usability volume

Increased in-basket burnout was associated with reported burnout and lower job satisfaction. Increased EHR documentation was also linked to increased burnout, but researchers found it was unrelated to EHR satisfaction. Increased clicks were also associated with increased burnout.  

Weekly EHR use time

One study said increased weekly EHR use time was associated with increased emotional exhaustion. However, a second study said spending more time in the EHR during the week was associated with a lower burnout score. A third study reported increased EHR time was related to higher EHR satisfaction.

“Increased time spent using the EHR after hours was related to higher burnout scores, worse EHR frustration levels, and more work-life balance concerns,” the study authors wrote. “However, one study found residents reported higher depersonalization and lower personal accomplishment scores as EHR typing time spent after-hours working in the EHR increased, compared with attending physicians who reported no association with depersonalization scores and higher personal accomplishment scores.”

A more recent study reported increased burnout when EHR utilization went into the weekend, holidays, and days with multiple patient appointments.

Clinician recommendations

The researchers found 12 studies that focused on federal policy, organizational policy and health IT features tied to well-being and EHR burnout.

“For instance, federal policy interventions focused on decreasing documentation requirements, organizational policy suggestions focused on implementing team-based care or documentation models, and proposed IT solutions were aimed at usability issues and tools to improve personal productivity,” wrote the study authors.

Clinician recommendations were connected to all sociotechnical models of health IT. This showed the diverse origins of identified burnout pain points.

“Future research should assess multipronged interventions that address these factors,” concluded the researchers. “As primary stakeholders, physicians should be included in the planning and implementation of such modifications to ensure compatibility with physician needs and clinical workflows.”

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