Associations of physician burnout with organizational electronic health record support and after-hours charting

Eschenroeder, H C; Manzione, Lauren; Adler‐Milstein, Julia; Bice, Connor; Cash, R. S. G.; Duda, Cole; Joseph, Craig; Lee, John S.; Maneker, Amy; Poterack, Karl A.; Rahman, Sarah; Jeppson, Jacob; Longhurst, Christopher A.

doi:10.1093/jamia/ocab053

Cited by 50 publications

(51 citation statements)

References 21 publications

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“…Physician stress and burnout, particularly associated with technology use, were issues of considerable interest prepandemic. 3 4 5 6 7 In the context of a public health crisis that placed extraordinary responsibilities on health care professionals and contributed to deterioration of work–life happiness, clinician well-being has become an even greater concern. 8 9 As telehealth adoption and availability grows, so does the need to understand providers' perceptions of its benefits, burdens, and barriers.…”

Section: Background and Significancementioning

confidence: 99%

Associations of Telehealth Care Delivery with Pediatric Health Care Provider Well-Being

et al. 2022

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Background The rapid, large-scale deployment of new health technologies can introduce challenges to clinicians who are already under stress. The novel coronavirus disease 19 (COVID-19) pandemic transformed health care in the United States to include a telehealth model of care delivery. Clarifying paths through which telehealth technology use is associated with change in provider well-being and interest in sustaining virtual care delivery can inform planning and optimization efforts. Objective This study aimed to characterize provider-reported changes in well-being and daily work associated with the pandemic-accelerated expansion of telehealth and assess the relationship of provider perceptions of telehealth effectiveness, efficiency, and work–life balance with desire for future telehealth. Methods A cross-sectional survey study was conducted October through November 2020, 6 months after the outbreak of COVID-19 at three children's hospitals. Factor analysis and structural equation modeling (SEM) were used to examine telehealth factors associated with reported change in well-being and desire for future telehealth. Results A total of 947 nontrainee physicians, advanced practice providers, and psychologists were surveyed. Of them, 502 (53.0%) providers responded and 467 (49.3%) met inclusion criteria of telehealth use during the study period. Of these, 325 (69.6%) were female, 301 (65.6%) were physicians, and 220 (47.1%) were medical subspecialists. Providers were 4.77 times as likely (95% confidence interval [CI]: 3.29–7.06) to report improved versus worsened well-being associated with telehealth. Also, 95.5% of providers (95% CI: 93.2–97.2%) wish to continue performing telehealth postpandemic. Our model explains 66% of the variance in telehealth-attributed provider well-being and 59% of the variance for future telehealth preference and suggests telehealth resources significantly influence provider-perceived telehealth care effectiveness which in turn significantly influences provider well-being and desire to perform telehealth. Conclusion Telehealth has potential to promote provider well-being; telehealth-related changes in provider well-being are associated with both provider-perceived effectiveness of telemedicine for patients and adequacy of telehealth resources.

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Section: Background and Significancementioning

confidence: 99%

Associations of Telehealth Care Delivery with Pediatric Health Care Provider Well-Being

et al. 2022

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“…When selecting which metrics to use to assess for physician burden, we used metrics that evaluate time spent in the EHR outside working hours. Studies have demonstrated associations between both self-reported [14][15][16] and objective 17 measures of time spent in the EHR with physician burnout as measured by validated surveys such as the Maslach Burnout Inventory survey and the AMA mini-Z measurement. We evaluated burden using the metrics: Descriptive statistics were generated for all eleven metrics across the three time periods among all physicians, by specialty group, and by gender.…”

Section: Accepted Manuscriptmentioning

confidence: 99%

Physician Electronic Health Record Usage as Affected by the COVID-19 Pandemic

Ruan

Beiser

et al. 2022

Appl Clin Inform

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Objectives: To utilize metrics from physician action logs to analyze volume, physician efficiency and burden as impacted by telemedicine implementation during the COVID-19 pandemic and physician characteristics such as gender, years since graduation and specialty category. Methods: We selected eleven metrics from Epic Signal, a functionality of the Epic electronic health record (EHR). Metrics measuring time spent in the EHR outside working hours were used as a correlate for burden. We performed an analysis of these metrics among active physicians at our institution across three time periods: pre-pandemic and telehealth implementation (August 2019), post-implementation of telehealth (May 2020), and follow-up (July 2020), and correlated them with physician characteristics. Results: Analysis of 495 physician showed that after the start of the pandemic, physicians overall had fewer appointments per day, higher same day visit closure rates, and spent less time writing notes in the EHR outside 7AM-7PM on patient scheduled days. Across all three time periods, male physicians had better EHR-defined “efficiency” measures and spent less time in the EHR outside working hours. Years since graduation only had modest associations with higher same day visit closure rates and appointments per day in May 2020. Specialty category was significantly associated with appointments per day and same day closure visit rates and also was a significant factor in the observed changes seen across the three time periods. Conclusion: Utilizing EHR-generated reports may provide a scalable and nonintrusive way to monitor trends in physician usage and experience to help guide health systems in increasing productivity and reducing burnout.

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“… 58 More recently, data from the KLAS Arch Collaborative found that physicians who reported their organization had done a “great job with EHR implementation, training, and support” were twice as likely to report lower burnout scores. 59 Children's Hospital of Philadelphia created a more customized one-on-one training and efficiency program for their physicians and were able to reduce burnout rates from 32% to 23%. 60 …”

Section: Organizational Interventionsmentioning

confidence: 99%