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. 2024 Aug 1;7(8):e2426956.
doi: 10.1001/jamanetworkopen.2024.26956.

Electronic Health Record Usability, Satisfaction, and Burnout for Family Physicians

A Jay Holmgren  1 , Nathaniel Hendrix  2 , Natalya Maisel  1 , Jordan Everson  3 , Andrew Bazemore  2 , Lisa Rotenstein  1 , Robert L Phillips  2 , Julia Adler-Milstein  1
Affiliations

Electronic Health Record Usability, Satisfaction, and Burnout for Family Physicians

A Jay Holmgren et al. JAMA Netw Open. .

Abstract

Importance: Electronic health record (EHR) work has been associated with decreased physician well-being. Understanding the association between EHR usability and physician satisfaction and burnout, and whether team and technology strategies moderate this association, is critical to informing efforts to address EHR-associated physician burnout.

Objectives: To measure family physician satisfaction with their EHR and EHR usability across functions and evaluate the association of EHR usability with satisfaction and burnout, as well as the moderating association of 4 team and technology EHR efficiency strategies.

Design, setting, and participants: This study uses data from a cross-sectional survey conducted from December 12, 2021, to October 17, 2022, of all family physicians seeking American Board of Family Medicine recertification in 2022.

Exposure: Physicians perceived EHR usability across 6 domains, as well as adoption of 4 EHR efficiency strategies: scribes, support from other staff, templated text, and voice recognition or transcription.

Main outcomes and measures: Physician EHR satisfaction and frequency of experiencing burnout measured with a single survey item ("I feel burned out from my work"), with answers ranging from "never" to "every day."

Results: Of the 2067 physicians (1246 [60.3%] younger than 50 years; 1051 men [50.9%]; and 1729 [86.0%] practicing in an urban area) who responded to the survey, 562 (27.2%) were very satisfied and 775 (37.5%) were somewhat satisfied, while 346 (16.7%) were somewhat dissatisfied and 198 (9.6%) were very dissatisfied with their EHR. Readability of information had the highest usability, with 543 physicians (26.3%) rating it as excellent, while usefulness of alerts had the lowest usability, with 262 physicians (12.7%) rating it as excellent. In multivariable models, good or excellent usability for entering data (β = 0.09 [95% CI, 0.05-0.14]; P < .001), alignment with workflow processes (β = 0.11 [95% CI, 0.06-0.16]; P < .001), ease of finding information (β = 0.14 [95% CI, 0.09-0.19]; P < .001), and usefulness of alerts (β = 0.11 [95% CI, 0.06-0.16]; P < .001) were associated with physicians being very satisfied with their EHR. In addition, being very satisfied with the EHR was associated with reduced frequency of burnout (β = -0.64 [95% CI, -1.06 to -0.22]; P < .001). In moderation analysis, only physicians with highly usable EHRs saw improvements in satisfaction from adopting efficiency strategies.

Conclusions and relevance: In this survey study of physician EHR usability and satisfaction, approximately one-fourth of family physicians reported being very satisfied with their EHR, while another one-fourth reported being somewhat or very dissatisfied, a concerning finding amplified by the inverse association between EHR satisfaction and burnout. Electronic health record-based alerts had the lowest reported usability, suggesting EHR vendors should focus their efforts on improving alerts. Electronic health record efficiency strategies were broadly adopted, but only physicians with highly usable EHRs realized gains in EHR satisfaction from using these strategies, suggesting that EHR burden-reduction interventions are likely to have heterogenous associations across physicians with different EHRs.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Holmgren reported receiving grants from the American Medical Association, the Office of the National Coordinator for Health Information Technology, and the California Health Care Foundation outside the submitted work. Dr Maisel reported receiving grants from the American Board of Family Medicine during the conduct of the study. Dr Bazemore reported working for the American Board of Family Medicine and its Center for Professionalism & Value in Healthcare, which have longitudinal interests in improving user experience with health information technology and interoperability as a matter of enhancing the professional work environment for our diplomates. Dr Rotenstein reported receiving grants from the American Medical Association, FeelBetter Inc, and the Physicians Foundation and personal fees from Phreesia Inc and serving on the advisory board for Augmedix AI outside the submitted work. Dr Adler-Milstein reported serving on the AI Advisory Council and holding shares in Augmedix AI. No other disclosures were reported.

Figures

Figure 1.
Figure 1.. Physician Satisfaction With Their Electronic Health Record (EHR)
NA indicates not applicable.
Figure 2.
Figure 2.. Electronic Health Record Usability by Function
NA indicates not applicable.
Figure 3.
Figure 3.. Physician Use of Efficiency Strategies and Team-Based Support to Reduce Electronic Health Record Burden
Figure 4.
Figure 4.. Moderation Analysis Between Usability, Burden-Reduction Strategies, and Satisfaction
Results from multivariable regression model including controls for electronic health record (EHR) vendor, rurality, organization type, value-based payment participation, organization size, physician age, and physician gender. High usability indicates the respondent is 1 SD above the mean, while low usability indicates 1 SD below the mean in our standardized usability index. Error bars indicate 95% CIs from regression postestimation calculations.
See this image and copyright information in PMC

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