New findings link physician dissatisfaction and professional burnout to use of electronic health records (EHRs) and computerized physician order entry (CPOE), according to large nationwide study published in the July issue of Mayo Clinic Proceedings.
“Electronic health records hold great promise for enhancing coordination of care and improving quality of care,” said lead author Tait Shanafelt, MD, Director of the Mayo Clinic Department of Medicine Program on Physician Well-being. “In their current form and implementation, however, they have had a number of unintended negative consequences, including reducing efficiency, increasing clerical burden, and increasing the risk of burnout for physicians.”
Large Nationwide Survey
In collaboration with investigators from the American Medical Association (AMA), researchers from Mayo Clinic surveyed a national sample of U.S. physicians in active practice using the AMA Physician Masterfile between August and October 2014. The survey included validated metrics to assess burnout, as well as items developed specifically for the study to evaluate the electronic practice environment of the participating physicians.
The study included data from 6,560 physicians in active clinical practice surveyed between August and October 2014. Responses from 6,375 physicians showed a high uptake of EHRs in practice (84.5%). In addition, CPOE was used by 82.5% of the 5,892 physicians who said this technology is relevant to their specialty.
The majority of respondents who used EHRs were very dissatisfied (16.5%), dissatisfied (27.2%), or neither satisfied nor dissatisfied with this tool (20.3%). Similar rates of dissatisfaction were found for use of CPOE: 12.6% were very dissatisfied, 28.3% were dissatisfied, and 20% were neither satisfied nor dissatisfied with this technology.
Physician satisfaction with clerical burden, EHRs and CPOE varied markedly by specialty. Family medicine physicians, urologists, otolaryngologists, and neurologists had the lowest satisfaction with clerical burden, while pathologists and radiologists had the highest satisfaction.
Use of EHRs and CPOE was associated with lower satisfaction with clerical burden (odds ratio [OR]=0.67 and 0.72; P<0.001) in a multivariate analysis that adjusted for age, sex, specialty, practice setting, and hours worked per week. In addition, CPOE was associated with a greater risk of burnout in multivariate analysis (OR=1.29; P<0.001).
Further research is needed to determine if the observed associations are causal, the study investigators noted.
Negative Fallout From EHRs
“Although EHRs, electronic prescribing, and CPOE have been touted as ways to improve quality of care, these tools also create clerical burden, cognitive burden, frequent interruptions and distraction—all of which can contribute to physician burnout,” Dr. Shanafelt said. “Burnout has been shown to erode quality of care, increase risk of medical errors, and lead physicians to reduce clinical work hours, suggesting that the net effect of these electronic tools on quality of care for the U.S. health care system is less clear.”
“My colleagues feel burdened and feel that they do not spend enough time with patients because of the amount of time spent documenting the visit with patients,” Dr. Apovian said. “I do not feel using EHR and CPOE is a good use of my time.”
Strategies for Reducing the Burden of EHRs
To mitigate these negative effects of the electronic environment on physicians, Dr. Shanafelt recommended finding ways to incorporate these tools in a manner that does not increase clerical burden for physicians or reduce efficiency.
“I believe that each physician should have a scribe,” Dr. Apovian said. She added that this study represents “the general trend in American medicine to spend less time talking and examining the patient, and more time filling out paperwork and on EHRs. I think it will take a national movement to improve diagnostic care and medicine in the United States.”
August 2, 2016
Shanafelt TD, Dyrbye LN, Sinsky C, et al. Relationship between clerical burden and characteristics of the electronic environment with physician burnout and professional satisfaction. Mayo Clin Proc. 2016;91(7):836-848.