- Electronic health record systems create "information overload" for many clinicians, according to a new study published in JAMA Network Open that suggested vendors work to mitigate that issue in future designs to reduce physician burnout.
- The most prevalent concerns from the roughly 280 clinicians surveyed were excessive data entry requirements, long cut-and-pasted notes, inaccessibility of information from different institutions, notes geared toward billing and interference with work-life balance.
- However, other workplace factors, including the chaotic atmosphere of hospitals and practices and lack of workload control, may contribute as strongly to burnout, researchers funded by the Agency for Healthcare Research and Quality concluded.
When electronic health record systems began gaining traction in the late 1990s, they were touted as a way to boost the efficiency of medical practices. But those practicing medicine have often begged to differ.
Data from the study in JAMA Open, authored by physicians and researchers from institutions of higher learning such as Stanford and the University of Mexico and hospitals and healthcare systems in California, Colorado and Minnesota, reinforced the uneasy relationship clinicians have with EHRs.
Nearly 75% of surveyed clinicians said they felt under time pressure to perform appropriate documentation, more than 60% said they spent moderately high or even excessive time on EHR-related work at home and 45% described symptoms of burnout.
However, the study participants, including physicians, nurse practitioners and physician assistants across five disciplines, were sanguine about some features of EHRs. Nearly 70% approved of being able to message colleagues electronically, and nearly half were happy they could share results with patients. And, despite the grumbling about having to work at home, more than three-quarters said they liked being able to access their EHR systems remotely.
However, nearly 87% disapproved of what they believed were excessive data entry requirements, more than 75% disliked having to cut and paste excessively long progress notes and more than 73% disliked having to wade through notes more geared toward billing than patient care. Significant numbers also complained that the positioning of EHR screens caused posture and pain issues.
The study noted that “documentation requirements for billing purposes is an EHR design characteristic associated with both stress and burnout,” and that expansion of EHR use has led to many clinicians performing what were once clerical tasks.
The authors suggested that a path toward improving EHR systems for clinicians may be created by borrowing a page from the aviation industry, which has a user interface design called 'quiet dark.' In these systems, information isn't displayed unless something goes wrong or requires the pilot's attention.
"Arguably, the current state of EHR design is ‘loud bright,’ where virtually all information, normal or otherwise, appears in relatively the same manner regardless of its importance to the clinician or patient," researchers wrote. "Applying this [quiet dark] philosophy to EHR design could potentially reduce the amount of unnecessary data displayed based on particular users’ need and context, reducing the information overload problem."
But authors also found burnout strongly linked to non-EHR issues like chaotic workplaces, lack of control over schedules and poor communication. Tackling the problem of burnout means taking these issues on as well, they said.