Using objective clinical metrics to understand the relationship between the electronic health record and physician well-being: observational pilot study

Abstract

Background Electronic health records (EHRs) are a significant contributor to physicians’ low satisfaction, reduced engagement and increased burnout. Yet the majority of evidence around EHR and physician harms is based on self-reported screen time, which may both over- and underreport actual exposure. Aims The purpose of this study was to examine how objective EHR use correlates with physician well-being and to develop preliminary recommendations for well-being-based EHR interventions. Method Prior to the onset of COVID-19, psychiatry residents and attending physicians working in an out-patient clinic at an academic medical centre provided consent for access to EHR-usage logs and completed a well-being assessment made up of three scales: the Maslach Burnout Inventory, the Urecht Work Engagement Scale and the Professional Quality of Life Measure. Survey responses and objective EHR data were analysed with descriptive statistics. Results Responses were obtained from 20 psychiatry residents (total eligible residents n = 27; 74% participation) and 16 clinical faculty members (total eligible faculty n = 24; 67% participation) with an overall response rate of 71% (total eligible residents and faculty n = 51 and total residents and faculty who completed survey n = 36). Moderate correlations for multiple well-being domains emerged in analysis for all participants, especially around the time spent per note and patient visits closed the same day. Conclusions EHR-usage logs represent an objective tool in the evaluation and enhancement of physician well-being. Results from our pilot study suggest that metrics for note writing efficiency and closing patient visits the same day are associated with physician well-being. These metrics will be important to study in ongoing efforts involving well-being-based EHR interventions.

Using event logs to observe interactions with electronic health records: an updated scoping review shows increasing use of vendor-derived measures

“…Most studies were observational (91 articles) while a minority were experimental (11 articles). Nine of the observational studies examined associations between EHR use and an outcome in the cohort of observed users such as burnout, 6 , 7 , 33 , 46 , 47 , 67 , 69 turnover, 28 and stress. 71 Three observational studies examined associations between EHR use and clinical outcomes including next-day discharge, 78 length of stay, 84 and speed of consult response.…”

“… 75 , 93 , 94 , 113 Only one of the experimental studies was a randomized controlled trial. 75 Across both observational and experimental studies, 41 articles compared EHR use across different groups of users including comparisons by specialty (14 studies), 4 , 7 , 25 , 29 , 31 , 36 , 42 , 48 , 51 , 58 , 59 , 85 , 105 , 115 clinical role (12), 24 , 26 , 33 , 37 , 46 , 65 , 76 , 95 , 99 , 106 , 108 , 115 gender (8), 19 , 34 , 47 , 49 , 66 , 68 , 70 , 106 year in residency (8), 31 , 32 , 35 , 39 , 52 , 56 , 57 , 95 organization (3), 24 , 44 , 75 and country (1). 27 Vendor-measure studies were more likely than investigator-measure studies to make such comparisons of EHR use by user group (65% vs 25...…”

“…Reviewed articles mentioned several limitations of EHR log research ( Supplementary eTable 4 ). Three of the most frequently mentioned limitations echo those observed in the prior review of audit log research 11 : EHR logs do not provide a full view of clinical activity which can involve physical and digital interactions outside the EHR (22 articles), 3 , 26 , 34 , 43 , 55 , 57 , 58 , 61 , 65 , 68 , 73 , 74 , 84–86 , 89 , 91 , 92 , 95 , 103 , 109 , 112 qualitative methods are needed to better understand the context and motivation for observed work (15 articles), 32 , 46 , 53 , 62 , 64 , 68 , 72 , 80 , 85 , 91 , 96 , 97 , 101 , 115 , 118 and logs may not contain enough detail to observe complex workflows (13 articles). 4 , 26 , 32 , 43 , 51 , 56 , 59 , 69 , 75 , 81 , 89 , 90 ,…”

Effect of Telemedicine and the COVID-19 Pandemic on Medical Trainees' Usage of the Electronic Health Record in the Outpatient Setting

“…We selected eleven metrics of interest from the Montefiore Health Epic Signal database, consistent with prior research performed on patient volume, physician efficiency, and physician burnout. 18,[23][24][25] Using the Epic Signal web-based dashboard, we selected performance metrics displayed under 'Overview,' 'In Basket,' 'Notes and Letters,' and 'Workload' metrics as we hypothesized that these categories were most likely to be affected by the COVID-19 pandemic and resulting switch from in-person, to telehealth and hybrid models of care. Patient volume was assessed using number of appointments per day and total number of messages received per day.…”

Digital disparities among healthcare workers in typing speed between generations, genders, and medical specialties: cross sectional study

“…A pilot study on British physicians even suggested that more time spent on writing notes might be associated with a reduction in emotional wellbeing and engagement in work. 18 We sought to investigate the typing skills of the healthcare community in two large university hospitals in the Netherlands.…”