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
. 2021 May;12(3):507-517.
doi: 10.1055/s-0041-1731000. Epub 2021 Jun 2.

Impact of Changes in EHR Use during COVID-19 on Physician Trainee Mental Health

Katherine J Holzer  1 , Sunny S Lou  1 , Charles W Goss  2 , Jaime Strickland  3 , Bradley A Evanoff  3 , Jennifer G Duncan  4 , Thomas Kannampallil  1   5
Affiliations

Impact of Changes in EHR Use during COVID-19 on Physician Trainee Mental Health

Katherine J Holzer et al. Appl Clin Inform. 2021 May.

Abstract

Objectives: This article investigates the association between changes in electronic health record (EHR) use during the coronavirus disease 2019 (COVID-19) pandemic on the rate of burnout, stress, posttraumatic stress disorder (PTSD), depression, and anxiety among physician trainees (residents and fellows).

Methods: A total of 222 (of 1,375, 16.2%) physician trainees from an academic medical center responded to a Web-based survey. We compared the physician trainees who reported that their EHR use increased versus those whose EHR use stayed the same or decreased on outcomes related to depression, anxiety, stress, PTSD, and burnout using univariable and multivariable models. We examined whether self-reported exposure to COVID-19 patients moderated these relationships.

Results: Physician trainees who reported increased use of EHR had higher burnout (adjusted mean, 1.48 [95% confidence interval [CI] 1.24, 1.71] vs. 1.05 [95% CI 0.93, 1.17]; p = 0.001) and were more likely to exhibit symptoms of PTSD (adjusted mean = 15.09 [95% CI 9.12, 21.05] vs. 9.36 [95% CI 7.38, 11.28]; p = 0.035). Physician trainees reporting increased EHR use outside of work were more likely to experience depression (adjusted mean, 8.37 [95% CI 5.68, 11.05] vs. 5.50 [95% CI 4.28, 6.72]; p = 0.035). Among physician trainees with increased EHR use, those exposed to COVID-19 patients had significantly higher burnout (2.04, p < 0.001) and depression scores (14.13, p = 0.003).

Conclusion: Increased EHR use was associated with higher burnout, depression, and PTSD outcomes among physician trainees. Although preliminary, these findings have implications for creating systemic changes to manage the wellness and well-being of trainees.

PubMed Disclaimer

Conflict of interest statement

T.K. reports grants from NIMH, grants from NCATS, grants from NINR, personal fees from Pfizer, outside the submitted work. B.A.E. reports grants from National Institute of Occupational Safety and Health, from null, during the conduct of the study; grants from National Institute of Occupational Safety and Health, grants from National Institute of Health, from null, outside the submitted work.

Figures

Fig. 1
Fig. 1
Exposure to COVID-19 positive patients moderates relationship between overall EHR use and levels of burnout (left) and depression (right).
See this image and copyright information in PMC

References

    1. Huang J Z, Han M, Luo T, Ren A, Zhou X. Mental health survey of 230 medical staff in a tertiary infectious disease hospital for COVID-19. Chinese J Industrial Hygiene Occupat Dis. 2020;38:192–195. - PubMed
    1. Lai J, Ma S, Wang Y. Factors associated with mental health outcomes among health care workers exposed to coronavirus disease 2019. JAMA Netw Open. 2020;3(03):e203976–e203976. - PMC - PubMed
    1. Alexander G C, Tajanlangit M, Heyward J, Mansour O, Qato D M, Stafford R S. Use and content of primary care office-based vs telemedicine care visits during the COVID-19 pandemic in the US. JAMA Netw Open. 2020;3(10):e2021476–e2021476. - PMC - PubMed
    1. Hron J D, Parsons C R, Williams L A, Harper M B, Bourgeois F C. Rapid implementation of an inpatient telehealth program during the COVID-19 pandemic. Appl Clin Inform. 2020;11(03):452–459. - PMC - PubMed
    1. Knighton A J, Ranade-Kharkar P, Brunisholz K D. Rapid implementation of a complex, multimodal technology response to COVID-19 at an integrated community-based health care system. Appl Clin Inform. 2020;11(05):825–838. - PMC - PubMed