Conceptual considerations for using EHR-based activity logs to measure clinician burnout and its effects

Abstract

Electronic health records (EHR) use is often considered a significant contributor to clinician burnout. Informatics researchers often measure clinical workload using EHR-derived audit logs and use it for quantifying the contribution of EHR use to clinician burnout. However, translating clinician workload measured using EHR-based audit logs into a meaningful burnout metric requires an alignment with the conceptual and theoretical principles of burnout. In this perspective, we describe a systems-oriented conceptual framework to achieve such an alignment and describe the pragmatic realization of this conceptual framework using 3 key dimensions: standardizing the measurement of EHR-based clinical work activities, implementing complementary measurements, and using appropriate instruments to assess burnout and its downstream outcomes. We discuss how careful considerations of such dimensions can help in augmenting EHR-based audit logs to measure factors that contribute to burnout and for meaningfully assessing downstream patient safety outcomes.

Figure 1.

A. A systems-based conceptual model of physician burnout including the work-related factors and individual factors affecting physician burnout (see top half). B. Realization of the systems-oriented conceptual framework; the emotional exhaustion dimension of burnout can be captured through a combination of clinical activity measures, physiological behavioral measures, and personal factors. The list of sub-factors contributing to each of the factors are examples and are not meant to be exhaustive (see bottom half).