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University researchers link electronic health records, physician stress

Electronic health record use causes lower productivity, efficiency for physicians

Over the past few years, burnout among physicians has garnered more attention from researchers; and recently, a University study confirmed that stress related to electronic health records is common among doctors.

According to the study’s lead author, Associate Professor of Medicine at the Warren Alpert Medical School Rebekah Gardner, “the prevalence of stress related to technology was 70 percent among those who responded to the survey.” Today, ninety-one percent of physicians who participated in the study use EHRs, which they use to document their patient interactions digitally.

Before this study, the relationship between EHRs and physician burnout had not yet been measured. In an attempt to quantify the correlation, Gardner and her team of researchers added questions about EHR-related stress to a biannual technology survey that has been administered in Rhode Island for the past ten years. The research, which included responses from a large sample of practicing physicians in the state, was funded by the Rhode Island Department of Health.

Gardner’s study involved a much larger sample than previous studies. While past research has focused solely on primary care doctors, this survey went out to every doctor in the state, including medical specialists. After analyzing both doctors who responded and those who did not, the research team concluded that the groups were relatively similar and the results of this study could be generalized beyond Rhode Island.

Each of the questions in the study’s survey targeted a different type of technology-related stress; for example, the doctors were asked whether or not the EHR added to the frustration of their day, if they had enough time to document their records and how much time they spent on their EHR at home to take care of work-related tasks. If they answered yes to any one of the three questions, Gardner said, then they were approximately twice as likely to have burnout. In addition, Gardner’s team found that the prevalence of stress varied depending on the specialty of the doctor.

Physician burnout can have several implications. Patients who are cared for by burnt-out physicians have less satisfaction with their care and can be subject to more unnecessary tests and consoles, Gardner said.

According to Clinical Associate Professor of Medicine Elizabeth Toll, patient-physician interaction is very important for successful healthcare. Primary care doctors spend twice as much time on the computer as they do with their patients, and, as a result, patients do not feel very cared for, she added. As for the physicians, the use of EHRs causes a drop in productivity and a decrease in efficiency. Physicians also make more errors and are more likely to leave their job. Toll, who has been practicing medicine since 1992, discussed how the medical world needs more doctors as a result of the aging U.S. population.

This research has a wide range of applications. For example, Gardner suggests that EHR design could be improved. “EHR vendors, the companies that put together and sell EHR systems … should make a more intuitive user-interface,” Gardner said. The system is currently used for both billing and clinical purposes, but Gardner suggested that it should only be used for clinical reasons.

Toll added that removing the connection between how much a doctor writes and how much they get paid, as well as organizing visits around the patient rather than the computer, are potential solutions to physician burnout as well. Gardner says that healthcare organizations should administer their own surveys and decide what interventions to put into place.

Toll also suggested that scribes should be used for documentation and young physicians should be trained to be more patient-oriented — similar suggestions to those that recently appeared in a New Yorker article on the subject. Gardner’s study could not conclude whether scribes lower physician burn-out rate, but previous research has identified such a relationship.

“We need to work toward a world in which the computer is supporting care … rather than interfering with it,” Toll added in an email to The Herald.


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