Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2018 Jul;1(1):49-56.
doi: 10.1093/jamiaopen/ooy016. Epub 2018 Jun 11.

The electronic elephant in the room: Physicians and the electronic health record

Philip J Kroth  1   2 , Nancy Morioka-Douglas  3 , Sharry Veres  4 , Katherine Pollock  5 , Stewart Babbott  6 , Sara Poplau  7 , Katherine Corrigan  1 , Mark Linzer  7   8
Affiliations

The electronic elephant in the room: Physicians and the electronic health record

Philip J Kroth et al. JAMIA Open. 2018 Jul.

Abstract

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.

Keywords: electronic health records; health manpower; medical informatics; professional burnout.

PubMed Disclaimer

Conflict of interest statement

Conflict of interest statement. None declared.

Figures

Figure 1.
Figure 1.
Definitions.
Figure 2.
Figure 2.
MS-Squared focus group questions.
See this image and copyright information in PMC

References

    1. Shanafelt TD, Hasan O, Dyrbye LN, et al. Changes in burnout and satisfaction with work-life balance in physicians and the general us working population between 2011 and 2014. Mayo Clin Proc 2015; 90 (12): 1600–13. - PubMed
    1. Wallace JE, Lemaire JB, Ghali WA.. Physician wellness: A missing quality indicator. Lancet 2009; 374 (9702): 1714–21. - PubMed
    1. Williams ES, Manwell LB, Konrad TR, et al. The relationship of organizational culture, stress, satisfaction, and burnout with physician-reported error and suboptimal patient care: Results from the MEMO study. Health Care Manage Rev 2007; 32 (3): 203–12. - PubMed
    1. Dewa CS, Loong D, Bonato S, et al. The relationship between physician burnout and quality of healthcare in terms of safety and acceptability: A systematic review. BMJ Open 2017; 7 (6): e015141. - PMC - PubMed
    1. Turner TB, Dilley SE, Smith HJ, et al. The impact of physician burnout on clinical and academic productivity of gynecologic oncologists: A decision analysis. Gynecol Oncol 2017; 146 (3): 642–6. - PubMed

LinkOut - more resources