EHRs Are Fueling Physician Burnout. So, Now What?

^{Physician burnout is tied to health IT and the EHR, according to a new study.}

In the past, some in healthcare dismissed the question, almost as if it were inconceivable that the digital transformation could have profound, unintended, negative effects: How does health IT, most notably the electronic health record (EHR), contribute to stress and physician burnout? A new study suggests a strong link, finding that roughly 70 percent of physicians with EHRs experience health IT-related stress.

Here are some more striking findings from the survey: More than a quarter of physicians said they were battling at least one symptom of burnout. Nearly 65 percent said EHRs make their workday more frustrating, and prevalence of burnout broke 27 percent for physicians with EHRs, trumping their low-tech counterparts, whose physician burnout rate totaled just under 14 percent.

>> LISTEN: The Slow, Frustrating Rise of the Electronic Health Record

But who’s to blame for EHR-driven physician burnout? The government, with its tens of billions of dollars in incentives to promote EHR adoption? How about the big EHR companies — your Cerner, Allscripts, Epic and so on? Or do these troubling findings fall on the shoulders of tech-averse doctors who are simply stuck in their ways?

Physician Burnout and EHRs

If this study is anything to go by, the institutions and executives who employ physicians and structural forces behind reimbursements might be responsible for this sort of physician burnout. Consider this: 38 percent of physicians said they spent “moderately high or excessive time” on the EHR when they’re at home. Nearly half of all respondents pinned their EHR woes on insufficient documentation time — and less than 3 percent said they had “optimal time” to enter data. (What’s more, physician burnout and health IT stress varied by specialty, with family medicine bearing the brunt, followed closely by dermatology and hospital medicine. Physician burnout was also associated with women, the authors found.)

Doctors with inadequate documentation time, meanwhile, were 2.8 times more likely to suffer symptoms of physician burnout. Similarly, those who cited the EHR as a source of frustration or said they spent too much time on the EHR at home were also more likely to feel physician burnout.

All the while, 77 percent of physicians said EHRs improve billing — but just half said the tech improves patient care and clinical workflow, while fewer than 30 percent touted EHRs’ ability to boost their job satisfaction.

>> READ: Leaders Weigh In on Solutions for Physician Burnout

“Additionally, documentation time is generally not reimbursed, which may contribute to physicians’ frustration, particularly if, as our study shows, a majority of physicians feel that EHRs do not improve patient care,” the study authors, led by Rebekah Gardner, M.D., of Healthcentric Advisors and Brown University, wrote. “In other words, physicians may feel that they are spending a large portion of their time on complex and time-consuming work that does not benefit their patients.”

Fighting Physician Burnout and Health IT Stress

Gardner and her colleagues called for technical and user experience-driven fixes from EHR vendors, along with greater systemic changes to the reimbursement system. But they focused mostly on how healthcare organizations might overhaul their practices, change their culture and measure their successes and failures to fight health IT stress and physician burnout.

Some tips for healthcare organizations to quash physician burnout:

• “Regularly and systematically” measure health IT-related stress and physician burnout, stratifying by specialty
• Form focus groups comprising specialties with low rates of stress and physician burnout to see what’s working
• Launch evidence-based interventions — such as medical scribes, whom the study authors found, reduced physician burnout odds by 40 percent in one model — to streamline EHR documentation
• Adopt policies barring work email and tasks during vacation

The Price of Physician Burnout

In study after study and story after story, researchers and health-tech observers have detailed the negative effects of physician burnout and health IT stress.

The most glaring, of course, may well be physician suicide, a scourge that is gripping the profession. But physician burnout has also been linked to inadequate patient care, patient safety incidents, insufficient professionalism, low patient satisfaction ratings and even monetary costs to healthcare organizations. What’s more, physician burnout could force capable individuals to leave the field at a time when a physician shortage appears all but inevitable.

In the end, Gardner and her co-authors noted, it’s critical for healthcare organizations and other stakeholders to solve this growing problem.

“Given the toll of burnout on clinicians, patients and the healthcare system, measuring and addressing (health IT)-related stress is an important step in reducing workforce burden and improving the care of our patient,” Garner and her team wrote.

The authors of the study, published this month in the Journal of the American Medical Informatics Association, surveyed 1,792 physicians in Rhode Island. Researchers noted that the prevalence of physician burnout may actually be higher than reported because the survey was digital (meaning respondents must have been comfortable with using a computer) and doctors might have been wary to report burnout for fear of losing their medical license.

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