The Effect of EHR Requirements on Physician Burnout

Electronic Health Records (EHR) have long been seen as a potential work-saver for those in the medical industry. Allowing for faster transferability and easier accessibility of patient information, this system—mandated by the CMS (Centers for Medicare and Medicaid Services)—is meant to work in the benefit of both the patient and provider [1]. Some have recently reported, however, that the wide range of data required for EHR input by providers contributes to physician burnout.

The medical community has yet to build consensus around the issue, but the CMS has proposed certain updates in recent months and years to try and move toward a more standardized, updated EHR across all eligible hospitals. It requires ACOs to verify that a certain number of their clinicians are using EHR technology from 2015 or later. The shift, enacted at the beginning of 2019, aimed to increase interoperability so clinicians can more effectively exchange patient information [1, 2].

Some recent studies, however, point out that the sheer volume of EHR work that physicians are required to complete is increasing their feelings of burnout and will make them more likely to plan to work less in the coming year. In a study for the Journal of Graduate Medical Education, researchers conducted an anonymous survey of 19 primary care programs to gauge the problem. In all, 585 of 866 surveys (68%) were completed. According to the survey’s results, 75 percent of physicians who reported at least one symptom of burnout attributed EHR work as a source of their burnout. Further, respondents who spent more than 6 hours weekly after-hours completing EHR work were 2.9 times more likely to report burnout and 497 (85%) of all respondents said that EHR work affected their work-life balance. [3]

Another survey, conducted by researchers for HealthAffairs, focused primarily on how physician burnout and overall well-being was affected by in-basket messages generated by EHR’s automation. The study focused on one multispecialty practice, the Palo Alto Medical Foundation, and found that messages generated by the EHR system itself, as opposed to messages from colleagues and patients, accounted for the highest proportion (114) of the 243 weekly in-basket messages that physicians received on average. The researchers also found that, in the practice surveyed, physicians who received more than the average number of messages generated by the EHR system had a 40 percent higher likelihood of burnout and a 38 percent higher likelihood of intending to reduce their clinical work time. The authors concluded their report stating that “Collective actions are needed at the national and local organizational levels to bring about systematic changes to this previously little-known yet important source of friction,” in reference to the EHR-generated mass of in-basket messages. [4]

These issues were further pointed out by a recent article in Kaiser Health News (KHN). Less than two weeks after Judy Faulkner, CEO of leading EHR company Epic Systems, said there was no high correlation between use of EHR and physician burnout, KHN released a report that spoke to the contrary, linking explicitly use of EHR with physician burnout—among other issues such as errors in medical records. [5]

As claims and studies of EHR relating to physician burnout continue to proliferate, it will be important for the medical community to continue to adapt its use of the technology in accordance with these findings.

References

[1] Arndt, Rachel Z. “The CMS pushes for simpler EHR requirements for ACO physicians.” Modern Healthcare. 10 Aug. 2018. 10 July 2019 <https://www.modernhealthcare.com/article/20180810/NEWS/180819998/the-cms-pushes-for-simpler-ehr-requirements-for-aco-physicians>.

[2] “2019ProgramRequirementsMedicare.” CMS.gov Centers for Medicare & Medicaid Services. 08 May 2019. 10 July 2019 <https://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/2019ProgramRequirementsMedicare.html>.

[3] Robertson SL, Robinson MD, Reid A. Electronic Health Record Effects on Work-Life Balance and Burnout Within the I3 Population Collaborative. J Grad Med Educ. 2017. 9(4): p. 479–84.

[4] Tai-Seale, Ming, Ellis C. Dillon, Yan Yang, Robert Nordgren, Ruth L. Steinberg, Teresa Nauenberg, Tim C. Lee, Amy Meehan, Jinnan Li, Albert Solomon Chan, and Dominick L. Frosch. Physicians’ Well-Being Linked To In-Basket Messages Generated By Algorithms In Electronic Health Records. Health Affairs. 2019. 38(7): 1073-078.

[5] Schulte, Fred, and Erika Fry. “Death By 1,000 Clicks: Where Electronic Health Records Went Wrong.” Kaiser Health News. 11 June 2019. 10 July 2019 <https://khn.org/news/death-by-a-thousand-clicks/>.