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3 EHR Usability, Optimization Fixes That Address Clinician Burnout

EHR usability is a top cause of clinician burnout, but researchers and companies are looking to address this issue with new technology advancements in the EHR.

There are many positives associated with EHRs. However, EHR usability is a common negative among EHR users, which leads to clinician burnout.  

As the calendar flips to 2020, technological advancements in the EHR are key to addressing this epidemic that makes its way around medical facilities throughout the country.

According to a study completed in a partnership between the Mayo Clinic and the American Medical Association (AMA), researchers found that EHR usability was largely graded an “F” when evaluated on a traditional letter grade scale, and that failing grade was strongly tied to high clinician burnout scores.

“A new study issued today found electronic medical records (EHRs) - as currently designed, implemented and regulated - lack usability as a necessary feature, resulting in EHRs that are extremely hard to use compared to other common technologies,” said AMA President Patrice Harris in a statement.

“While the study was conducted by leading clinical institutions in collaboration with the American Medical Association (AMA), the findings will not come as a surprise to anyone who practices medicine,” continued Harris. “Too many physicians have experienced the demoralizing effects of cumbersome EHRs that interfere with providing first-rate medical care to patients.”

But when an EHR was deemed more usable, researchers observed a significant decrease in clinician burnout. A one percentage point increase in EHR usability equaled a 3 percent decrease in clinician burnout.

 “It is a national imperative to overhaul the design and use of EHRs and reframe the technology to focus primarily on its most critical function - helping physicians care for their patients,” said Harris. “Significantly enhancing EHR usability is key and the AMA is working to ensure a new generation of EHRs are designed to prioritize time with patients, rather than overload physicians with type-and-click tasks.”

To be clear, EHRs are not going away. Removing them from clinician workflows is not a realistic remedy for clinician burnout. But designing EHRs to be easier to use and to reduce the reporting burden many clinicians cite as a detriment to their workflows could help address burnout.

Integrating visual aids, adding voice-enabled technology, and using the EHR to prompt certain clinician behaviors may be some new EHR optimization projects that could ease clinician burnout.

Visual aids address EHR alert fatigue

After a clinician has ordered a test or medication, a new message can pop up on the EHR screen if that order is duplicative or erroneous. These disruptive alerts in the EHR have led to errors, an increase in mouse clicks, cognitive overload, and alert fatigue, leading to clinician burnout.

Researchers from Beth Israel Deaconess Medical Center implemented a simple visual aid in the EHR, rather than an interruptive alert. Instead of the alert, researchers set up an EHR visual aid that placed a simple red highlight around the checkbox of the order, alerting the clinician to a duplicative or incorrect test order.

In return, researchers found that this reduced the chances of duplicative orders, thus decreasing clinician burnout, according to a study in JAMA Network Open.

Following this implementation, researchers found a 49 percent decrease in unintentional duplicate orders for laboratory tests and a 40 percent decrease in unintentional duplicate orders for radiology tests.

 “In our EHR, it takes a minimum of 9 clicks and password entry to cancel an order,” researchers wrote. “Estimating the burden of order cancellation at 9 clicks and 30 seconds, the estimated reduction in unintended duplicate orders saved 17 936 clicks (not including the password) in the year after the intervention, which amounts to 16 hours and 36 minutes of regained productivity.”

Although EHRs have many positives surrounding patient care, these extra mouse clicks cause a cognitive overload that leads to burden or burnout.

“This type of EHR-based reminder may be a useful alternative to interruptive, post-order alerts for reducing duplicate order entry,” continued the researchers. “We believe guiding clinicians to a right action is better than telling the clinician they have made an error. This approach may help reduce alert fatigue and lessen clinician stress and burnout associated with EHRs.”

Voice-enabled technology aids documentation

Reporting requirements are also a significant detriment to clinician burnout, with burnout being a common outcome when clinicians need to document during patient visits.

The advancement in technology and implementation of voice-enabled add-ons in the EHR is set to tackle that issue. These add-ons will ease the cognitive overload, the amount of mouse clicks, and the constant change of computer screens it takes to utilize an EHR.

More specifically, voice-enabled technology allows clinicians to dictate their notes into the EHR, rather than having to take notes within the tool at the point of care. This allows the provider to carry on a more seamless, patient-centered encounter.

Technology companies are beginning to develop this type of technology.

With AWS diving into the medical field, the company announced the launch of Amazon Transcribe Medical, a speech recognition service that transcribed clinician and patient speech into text. Not only will the tool help physicians document small notes more effectively into the EHR or an app, but it will also transcribe entire conversations into text using correct punctuation.

The implementation of this add-on is designed to limit the amount of extensive note taking, a task that is a commonly linked to burnout and is labeled as a distraction. It also targets cognitive overload by saving the clinician time and mouse clicks.

“Extreme accuracy in clinical documentation is critical to workflows and overall caregiver satisfaction,” said Jacob Geers, solutions strategist at Cerner Corporation, an EHR vendor in using an early version of the tool.

“By leveraging Amazon Transcribe Medical's transcription API, Cerner is in initial development of a digital voice scribe that automatically listens to clinician-patient interactions and unobtrusively captures the dialogue in text form,” continued Geers. “From there, our solution will intelligently translate the concepts for entry into the codified component in the Cerner EHR system.”

Using EHR nudges for team-based care

Team-based care, or the partnership between physicians, nurses, advance practice practitioners, and medical assistants, has been touted as a key strategy for eliminating clinician burnout. This strategy should extend to the EHR, where medical assistants and other medical professionals can ease some of the burden off physicians and nurses.

Using the EHR to prompt medical assistants, rather than physicians, to set up and order screenings for physicians to sign once they see the patient is one solution being floated by researchers.

Due to doctors’ busy schedules and clinician burden, the scheduling of preventative screenings, such as cancer screenings, sometimes slips through the cracks.

According to a study published in the JAMA Network Open, an EHR nudge could address these issues.  

The EHR was a natural place to start, the researchers said. More than 90 percent of clinicians and health systems now use EHRs, making them accessible for study participants.

“Providers, especially primary care providers in the outpatient primary care setting, are expected to do so many different things in terms of addressing patient problems and remembering health maintenance screening, including cancer screenings and often increasingly shorter and shorter visits,” Esther Hsiang, MD, said in an interview with

Pushing the nudges out to medical assistants, rather than physicians, was a key strategy for addressing that burden, she continued.

“Just to try to relieve some of that burden, one way to think about it is to what degree can the use of emerging technologies or increased implementation of technologies help to flag some of those things more automatically to help address the issues of health maintenance themselves,” explained Hsiang.

Researchers at the University of Pennsylvania found a 22 percent increase in screening orders for breast cancer and a 14 percent increase for those treating colorectal cancer. Overall, 88 percent of the breast cancer patients and 82 percent of colorectal patients included in the study had a cancer screening ordered due to the nudges.

The healthcare industry has reached near ubiquitous adoption and use of the EHR, cementing the technology as a mainstay in the field. But as medical professionals continue to experience burnout symptoms, often at the hands of those EHRs, it is clear technology developers need to make a change.

By implementing tools to reduce alert fatigue, streamline workflows, and enable team-based care, technology developers and clinician partners can begin chipping away at clinician burnout.

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