Objective To quantify how stress related to use of health information technology (HIT) predicts burnout among physicians. Methods All 4197 practicing physicians in Rhode Island were surveyed in 2017 on their HIT use. Our main outcome was self-reported burnout. The presence of HIT-related stress was defined by report of at least 1 of the following: poor/marginal time for documentation, moderately high/excessive time spent on the electronic health record (EHR) at home, and agreement that using an EHR adds to daily frustration. We used logistic regression to assess the association between each HIT-related stress measure and burnout, adjusting for respondent demographics, practice characteristics, and the other stress measures. Results Of the 1792 physician respondents (43% response rate), 26% reported burnout. Among EHR users (91%), 70% reported HIT-related stress, with the highest prevalence in primary care-oriented specialties. After adjustment, physicians reporting poor/marginal time for documentation had 2.8 times the odds of burnout (95% CI: 2.0–4.1; P < .0001), compared to those reporting sufficient time. Physicians reporting moderately high/excessive time on EHRs at home had 1.9 times the odds of burnout (95% CI: 1.4–2.8; P < .0001), compared to those with minimal/no EHR use at home. Those who agreed that EHRs add to their daily frustration had 2.4 times the odds of burnout (95% CI: 1.6–3.7; P < .0001), compared to those who disagreed. Conclusion HIT-related stress is measurable, common (about 70% among respondents), specialty-related, and independently predictive of burnout symptoms. Identifying HIT-specific factors associated with burnout may guide healthcare organizations seeking to measure and remediate burnout among their physicians and staff.
IMPORTANCE Many believe a major cause of the epidemic of clinician burnout is poorly designed electronic health records (EHRs). OBJECTIVES To determine which EHR design and use factors are associated with clinician stress and burnout and to identify other sources that contribute to this problem. DESIGN, SETTING, AND PARTICIPANTS This survey study of 282 ambulatory primary care and subspecialty clinicians from 3 institutions measured stress and burnout, opinions on EHR design and use factors, and helpful coping strategies. Linear and logistic regressions were used to estimate associations of work conditions with stress on a continuous scale and burnout as a binary outcome from an ordered categorical scale. The survey was conducted between August 2016 and July 2017, with data analyzed from January 2019 to May 2019. MAIN OUTCOMES AND MEASURES Clinician stress and burnout as measured with validated questions, the EHR design and use factors identified by clinicians as most associated with stress and burnout, and measures of clinician working conditions. RESULTS Of 640 clinicians, 282 (44.1%) responded. Of these, 241 (85.5%) were physicians, 160 (56.7%) were women, and 193 (68.4%) worked in primary care. The most prevalent concerns about EHR design and use were excessive data entry requirements (245 [86.9%]), long cut-and-pasted notes (212 [75.2%]), inaccessibility of information from multiple institutions (206 [73.1%]), notes geared toward billing (206 [73.1%]), interference with work-life balance (178 [63.1%]), and problems with posture (144 [51.1%]) and pain (134 [47.5%]) attributed to the use of EHRs. Overall, EHR design
Objectives Determine the specific aspects of health information and communications technologies (HICT), including electronic health records (EHRs), most associated with physician burnout, and identify effective coping strategies. Materials and methods We performed a qualitative analysis of transcripts from 2 focus groups and a burnout assessment of ambulatory physicians—each at 3 different health care institutions with 3 different EHRs. Results Of the 41 clinicians, 71% were women, 98% were physicians, and 73% worked in primary care for an average of 11 years. Only 22% indicated sufficient time for documentation. Fifty-six percent noted “a great deal of stress” because of their job. Forty-two percent reported “poor” or “marginal” control over workload. Even though 90% reported EHR proficiency, 56% indicated EHR time at home was “excessive” or “moderately high.” Focus group themes included HICT “successes” where all patients’ information is accessible from multiple locations. HICT “stressors” included inefficient user interfaces, unpredictable system response times, poor interoperability between systems and excessive data entry. “Adverse outcomes” included ergonomic problems (eg, eye strain and hand, wrist, and back pain) and decreased attractiveness of primary care. Suggested “organizational changes” included EHR training, improved HICT usability, and scribes. “Personal/resilience” strategies focused on self-care (eg, exercise, maintaining work-life boundaries, and positive thinking). Discussion and conclusion HICT use, while beneficial in many ways for patients and providers, has also increased the burden of ambulatory practice with personal and professional consequences. HICT and clinic architectural and process redesign are likely necessary to make significant overall improvements.
PURPOSEThe advent of Web-based survey tools has provided the investigator with an alternative to paper-based survey methods that in many instances may be less expensive to implement than traditional paper-based surveys. Newer technology, however, does not diminish the importance of obtaining an adequate response rate. METHODSWe analyzed response rate data obtained from a survey implemented across 3 practice-based research networks (PBRNs) in which the survey was fi rst implemented electronically with 5 rounds of electronic solicitation for an Internet-based questionnaire and then by 2 rounds of a paper-based version mailed only to nonresponders.RESULTS Overall, 24% of the total survey responses received were in the paper mode despite intense promotion of the survey in the electronic phase.CONCLUSIONS Our results suggest there is still an important role for the use of paper-based methods in PBRN survey research. Both hard copy and electronic survey collection methods may be required to enhance clinician response rates in PBRNs. INTRODUCTIONR esearch using surveys for data collection is common in practicebased research networks (PBRNs). The continuing growth of electronic communications, potential for cost savings, and more rapid results has created interest in Internet-based survey designs. Regardless of the method or technology used in performing a survey, it is clear that an adequate response rate is still critical to the scientifi c validity of survey fi ndings.1 Several investigators have shown that the mode of the survey measurably affects response rates in various biomedical venues.2 Our objective was to ascertain the value of a paper follow-up to an electronically based survey conducted on clinicians across 3 PBRNs . METHODSWe performed a secondary, retrospective analysis on data obtained from a completed survey on clinician attitudes toward the screening and treatment of hepatitis C. The survey was conducted in the Primary Care Multi-Ethnic Research Network (PRIME Net).3 At the time of this study, PRIME Net was a collaboration of W EB -BA SED A ND M A IL SURV E Y SThe survey instrument 7 consisted of 28 questions exploring clinicians' approaches to hepatitis C in their practices and available resources for care of patients infected with the hepatitis C virus.Invitations to participate in the survey were sent to all 805 active clinician members of the 3 PRIME Net PBRNs for whom a valid e-mail and postal address was available. Before the survey began, clinicians received 1 or more advance e-mail messages from their home PBRN describing the purpose of the survey and requesting participation.At the start of the survey, each clinician received a personalized e-mail solicitation from his or her home PBRN with a link to the Web-based version of the survey. The customized link had the target's unique identifying code embedded to provide automatic log-in and response identifi cation. We repeated the e-mail solicitation to nonresponders at intervals of 1 to 2 weeks for a total of 5 e-mail solicitations. ...
BackgroundA growing body of literature shows that patients accept the use of computers in clinical care. Nonetheless, studies have shown that computers unequivocally change both verbal and non-verbal communication style and increase patients' concerns about the privacy of their records. We found no studies which evaluated the use of Electronic Health Records (EHRs) specifically on psychiatric patient satisfaction, nor any that took place exclusively in a psychiatric treatment setting. Due to the special reliance on communication for psychiatric diagnosis and evaluation, and the emphasis on confidentiality of psychiatric records, the results of previous studies may not apply equally to psychiatric patients.MethodWe examined the association between EHR use and changes to the patient-psychiatrist relationship. A patient satisfaction survey was administered to psychiatric patient volunteers prior to and following implementation of an EHR. All subjects were adult outpatients with chronic mental illness.ResultsSurvey responses were grouped into categories of "Overall," "Technical," "Interpersonal," "Communication & Education,," "Time," "Confidentiality," "Anxiety," and "Computer Use." Multiple, unpaired, two-tailed t-tests comparing pre- and post-implementation groups showed no significant differences (at the 0.05 level) to any questionnaire category for all subjects combined or when subjects were stratified by primary diagnosis category.ConclusionsWhile many barriers to the adoption of electronic health records do exist, concerns about disruption to the patient-psychiatrist relationship need not be a prominent focus. Attention to communication style, interpersonal manner, and computer proficiency may help maintain the quality of the patient-psychiatrist relationship following EHR implementation.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.