1
|
Huang JS, Bialostozky M. Electronic medical record clinical workload metrics from 10,210 gastroenterologists in North America. J Pediatr Gastroenterol Nutr 2024; 79:558-563. [PMID: 39034484 DOI: 10.1002/jpn3.12313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Revised: 05/30/2024] [Accepted: 06/03/2024] [Indexed: 07/23/2024]
Abstract
In the United States, clinical work had been primarily compensated via a relative value unit (RVU) system reliant on professional surveys estimating the value of clinical care events. However, with the advent of time-based billing in 2021, time accounting has become an important work compensation metric. The Signal functionality within Epic, the most widely used electronic medical record (EMR) system in North America, tracks clinician time within the system. We extracted Epic Signal data from 10,200 gastroenterologists at 356 North American institutions for analysis. Workload metrics were reported as group median (interquartile range) per month and comparisons were performed using nonparametric testing. Gastroenterologists exhibit different EMR time patterns based on clientele and practice arenas. Compared with counterparts, pediatric and academic gastroenterologists spend more time at each encounter which had not been compensated under prior RVU valuations. Clinical compensation benchmarks should be driven by time-based workload metrics to ensure appropriate compensation.
Collapse
Affiliation(s)
- Jeannie S Huang
- University of California San Diego School of Medicine, La Jolla, California, USA
- Rady Children's Hospital, San Diego, California, USA
| | - Mario Bialostozky
- University of California San Diego School of Medicine, La Jolla, California, USA
- Rady Children's Hospital, San Diego, California, USA
| |
Collapse
|
2
|
Tawfik D, Bayati M, Liu J, Nguyen L, Sinha A, Kannampallil T, Shanafelt T, Profit J. Predicting Primary Care Physician Burnout From Electronic Health Record Use Measures. Mayo Clin Proc 2024; 99:1411-1421. [PMID: 38573301 PMCID: PMC11374508 DOI: 10.1016/j.mayocp.2024.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 01/08/2024] [Indexed: 04/05/2024]
Abstract
OBJECTIVE To evaluate the ability of routinely collected electronic health record (EHR) use measures to predict clinical work units at increased risk of burnout and potentially most in need of targeted interventions. METHODS In this observational study of primary care physicians, we compiled clinical workload and EHR efficiency measures, then linked these measures to 2 years of well-being surveys (using the Stanford Professional Fulfillment Index) conducted from April 1, 2019, through October 16, 2020. Physicians were grouped into training and confirmation data sets to develop predictive models for burnout. We used gradient boosting classifier and other prediction modeling algorithms to quantify the predictive performance by the area under the receiver operating characteristics curve (AUC). RESULTS Of 278 invited physicians from across 60 clinics, 233 (84%) completed 396 surveys. Physicians were 67% women with a median age category of 45 to 49 years. Aggregate burnout score was in the high range (≥3.325/10) on 111 of 396 (28%) surveys. Gradient boosting classifier of EHR use measures to predict burnout achieved an AUC of 0.59 (95% CI, 0.48 to 0.77) and an area under the precision-recall curve of 0.29 (95% CI, 0.20 to 0.66). Other models' confirmation set AUCs ranged from 0.56 (random forest) to 0.66 (penalized linear regression followed by dichotomization). Among the most predictive features were physician age, team member contributions to notes, and orders placed with user-defined preferences. Clinic-level aggregate measures identified the top quartile of clinics with 56% sensitivity and 85% specificity. CONCLUSION In a sample of primary care physicians, routinely collected EHR use measures demonstrated limited ability to predict individual burnout and moderate ability to identify high-risk clinics.
Collapse
Affiliation(s)
- Daniel Tawfik
- Stanford University School of Medicine, Stanford, CA.
| | | | - Jessica Liu
- Stanford University School of Medicine, Stanford, CA
| | - Liem Nguyen
- Stanford University School of Engineering, Stanford, CA
| | | | | | - Tait Shanafelt
- Stanford University School of Medicine, Stanford, CA; Stanford Medicine WellMD & WellPhD Center, Stanford, CA
| | - Jochen Profit
- Stanford University School of Medicine, Stanford, CA
| |
Collapse
|
3
|
Owens LM, Wilda JJ, Grifka R, Westendorp J, Fletcher JJ. Effect of Ambient Voice Technology, Natural Language Processing, and Artificial Intelligence on the Patient-Physician Relationship. Appl Clin Inform 2024; 15:660-667. [PMID: 38834180 PMCID: PMC11305826 DOI: 10.1055/a-2337-4739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Accepted: 05/31/2024] [Indexed: 06/06/2024] Open
Abstract
BACKGROUND The method of documentation during a clinical encounter may affect the patient-physician relationship. OBJECTIVES Evaluate how the use of ambient voice recognition, coupled with natural language processing and artificial intelligence (DAX), affects the patient-physician relationship. METHODS This was a prospective observational study with a primary aim of evaluating any difference in patient satisfaction on the Patient-Doctor Relationship Questionnaire-9 (PDRQ-9) scale between primary care encounters in which DAX was utilized for documentation as compared to another method. A single-arm open-label phase was also performed to query direct feedback from patients. RESULTS A total of 288 patients were include in the open-label arm and 304 patients were included in the masked phase of the study comparing encounters with and without DAX use. In the open-label phase, patients strongly agreed that the provider was more focused on them, spent less time typing, and made the encounter feel more personable. In the masked phase of the study, no difference was seen in the total PDRQ-9 score between patients whose encounters used DAX (median: 45, interquartile range [IQR]: 8) and those who did not (median: 45 [IQR: 3.5]; p = 0.31). The adjusted odds ratio for DAX use was 0.8 (95% confidence interval: 0.48-1.34) for the patient reporting complete satisfaction on how well their clinician listened to them during their encounter. CONCLUSION Patients strongly agreed with the use of ambient voice recognition, coupled with natural language processing and artificial intelligence (DAX) for documentation in primary care. However, no difference was detected in the patient-physician relationship on the PDRQ-9 scale.
Collapse
Affiliation(s)
- Lance M. Owens
- Department of Family Medicine, University of Michigan Health-West, Wyoming, Michigan, United States
| | - J Joshua Wilda
- Health Information Technology, University of Michigan Health-West, Wyoming, Michigan, United States
| | - Ronald Grifka
- Department of Research, University of Michigan Health West, Wyoming, Michigan, United States
| | - Joan Westendorp
- Department of Research, University of Michigan Health West, Wyoming, Michigan, United States
| | - Jeffrey J. Fletcher
- Department of Research, University of Michigan Health West, Wyoming, Michigan, United States
| |
Collapse
|
4
|
Murad MH, Vaa Stelling BE, West CP, Hasan B, Simha S, Saadi S, Firwana M, Viola KE, Prokop LJ, Nayfeh T, Wang Z. Measuring Documentation Burden in Healthcare. J Gen Intern Med 2024:10.1007/s11606-024-08956-8. [PMID: 39073484 DOI: 10.1007/s11606-024-08956-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2024] [Accepted: 07/17/2024] [Indexed: 07/30/2024]
Abstract
BACKGROUND The enactment of the Health Information Technology for Economic and Clinical Health Act and the wide adoption of electronic health record (EHR) systems have ushered in increasing documentation burden, frequently cited as a key factor affecting the work experience of healthcare professionals and a contributor to burnout. This systematic review aims to identify and characterize measures of documentation burden. METHODS We integrated discussions with Key Informants and a comprehensive search of the literature, including MEDLINE, Embase, Scopus, and gray literature published between 2010 and 2023. Data were narratively and thematically synthesized. RESULTS We identified 135 articles about measuring documentation burden. We classified measures into 11 categories: overall time spent in EHR, activities related to clinical documentation, inbox management, time spent in clinical review, time spent in orders, work outside work/after hours, administrative tasks (billing and insurance related), fragmentation of workflow, measures of efficiency, EHR activity rate, and usability. The most common source of data for most measures was EHR usage logs. Direct tracking such as through time-motion analysis was fairly uncommon. Measures were developed and applied across various settings and populations, with physicians and nurses in the USA being the most frequently represented healthcare professionals. Evidence of validity of these measures was limited and incomplete. Data on the appropriateness of measures in terms of scalability, feasibility, or equity across various contexts were limited. The physician perspective was the most robustly captured and prominently focused on increased stress and burnout. DISCUSSION Numerous measures for documentation burden are available and have been tested in a variety of settings and contexts. However, most are one-dimensional, do not capture various domains of this construct, and lack robust validity evidence. This report serves as a call to action highlighting an urgent need for measure development that represents diverse clinical contexts and support future interventions.
Collapse
Affiliation(s)
- M Hassan Murad
- Mayo Clinic Evidence-Based Practice Center, Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Healthcare Delivery, Mayo Clinic, Rochester, MN, USA.
| | - Brianna E Vaa Stelling
- Division of Community Internal Medicine, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Colin P West
- Division of General Internal Medicine, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Bashar Hasan
- Mayo Clinic Evidence-Based Practice Center, Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Healthcare Delivery, Mayo Clinic, Rochester, MN, USA
| | - Suvyaktha Simha
- Mayo Clinic Evidence-Based Practice Center, Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Healthcare Delivery, Mayo Clinic, Rochester, MN, USA
| | - Samer Saadi
- Mayo Clinic Evidence-Based Practice Center, Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Healthcare Delivery, Mayo Clinic, Rochester, MN, USA
| | - Mohammed Firwana
- Mayo Clinic Evidence-Based Practice Center, Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Healthcare Delivery, Mayo Clinic, Rochester, MN, USA
| | - Kelly E Viola
- Mayo Clinic Evidence-Based Practice Center, Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Healthcare Delivery, Mayo Clinic, Rochester, MN, USA
| | | | - Tarek Nayfeh
- Mayo Clinic Evidence-Based Practice Center, Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Healthcare Delivery, Mayo Clinic, Rochester, MN, USA
| | - Zhen Wang
- Mayo Clinic Evidence-Based Practice Center, Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Healthcare Delivery, Mayo Clinic, Rochester, MN, USA
| |
Collapse
|
5
|
Petersen FB, Mohty M, Blaise D. The doctor, the patient, and the computer. Clin Hematol Int 2024; 6:28-32. [PMID: 39050938 PMCID: PMC11268992 DOI: 10.46989/001c.121434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2024] [Accepted: 06/06/2024] [Indexed: 07/27/2024] Open
|
6
|
Lewin S, Chetty R, Ihdayhid AR, Dwivedi G. Ethical Challenges and Opportunities in Applying Artificial Intelligence to Cardiovascular Medicine. Can J Cardiol 2024:S0828-282X(24)00567-1. [PMID: 39038648 DOI: 10.1016/j.cjca.2024.06.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Revised: 06/03/2024] [Accepted: 06/12/2024] [Indexed: 07/24/2024] Open
Abstract
Much anticipation surrounds artificial intelligence's (AI) emergence as a promising tool in health care. It offers potential to revolutionise clinical practice through assistive and autonomous operation. The high prevalence of cardiac disease globally provides an opportunity for AI technology to increase health care efficiency and improve patient outcomes. This article explores the ethical considerations necessary for safe and acceptable implantation of AI within the health care space. We aim to highlight several challenges such as data privacy, consent, sustainability, and cybersecurity. In addition, we outline the future opportunities for AI use in cardiovascular medicine. Overall, we argue that AI deployment demands robust regulation, transparent algorithms, and safeguarding of patient privacy.
Collapse
Affiliation(s)
- Stephen Lewin
- Department of Cardiology, Fiona Stanley Hospital, Perth, Western Australia, Australia
| | - Riti Chetty
- Department of Cardiology, Fiona Stanley Hospital, Perth, Western Australia, Australia
| | - Abdul Rahman Ihdayhid
- Department of Cardiology, Fiona Stanley Hospital, Perth, Western Australia, Australia; Harry Perkins Institute of Medical Research, Perth, Western Australia, Australia; Medical School, Curtin University, Perth, Western Australia, Australia
| | - Girish Dwivedi
- Department of Cardiology, Fiona Stanley Hospital, Perth, Western Australia, Australia; Harry Perkins Institute of Medical Research, Perth, Western Australia, Australia; School of Medicine, University of Western Australia, Perth, Western Australia, Australia.
| |
Collapse
|
7
|
Weiner M, Flanagan ME, Ernst K, Cottingham AH, Rattray NA, Franks Z, Savoy AW, Lee JL, Frankel RM. Accuracy, thoroughness, and quality of outpatient primary care documentation in the U.S. Department of Veterans Affairs. BMC PRIMARY CARE 2024; 25:262. [PMID: 39026167 PMCID: PMC11264844 DOI: 10.1186/s12875-024-02501-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/07/2024] [Accepted: 06/27/2024] [Indexed: 07/20/2024]
Abstract
BACKGROUND Electronic health records (EHRs) can accelerate documentation and may enhance details of notes, or complicate documentation and introduce errors. Comprehensive assessment of documentation quality requires comparing documentation to what transpires during the clinical encounter itself. We assessed outpatient primary care notes and corresponding recorded encounters to determine accuracy, thoroughness, and several additional key measures of documentation quality. METHODS Patients and primary care clinicians across five midwestern primary care clinics of the US Department of Veterans Affairs were recruited into a prospective observational study. Clinical encounters were video-recorded and transcribed verbatim. Using the Physician Documentation Quality Instrument (PDQI-9) added to other measures, reviewers scored quality of the documentation by comparing transcripts to corresponding encounter notes. PDQI-9 items were scored from 1 to 5, with higher scores indicating higher quality. RESULTS Encounters (N = 49) among 11 clinicians were analyzed. Most issues that patients initiated in discussion were omitted from notes, and nearly half of notes referred to information or observations that could not be verified. Four notes lacked concluding assessments and plans; nine lacked information about when patients should return. Except for thoroughness, PDQI-9 items that were assessed achieved quality scores exceeding 4 of 5 points. CONCLUSIONS Among outpatient primary care electronic records examined, most issues that patients initiated in discussion were absent from notes, and nearly half of notes referred to information or observations absent from transcripts. EHRs may contribute to certain kinds of errors. Approaches to improving documentation should consider the roles of the EHR, patient, and clinician together.
Collapse
Affiliation(s)
- Michael Weiner
- Center for Health Information and Communication, Department of Veterans Affairs, Health Services Research and Development Service, Veterans Health Administration, Richard L. Roudebush VA Medical Center, CIN 13 416, Indianapolis, IN, USA.
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA.
- Indiana University Center for Health Services and Outcomes Research, Regenstrief Institute, Inc, 1101 West 10th Street, 46202-4800, Indianapolis, IN, USA.
| | - Mindy E Flanagan
- Center for Health Information and Communication, Department of Veterans Affairs, Health Services Research and Development Service, Veterans Health Administration, Richard L. Roudebush VA Medical Center, CIN 13 416, Indianapolis, IN, USA
| | - Katie Ernst
- Applied Decision Science LLC, Cincinnati, OH, USA
| | - Ann H Cottingham
- Indiana University Center for Health Services and Outcomes Research, Regenstrief Institute, Inc, 1101 West 10th Street, 46202-4800, Indianapolis, IN, USA
| | - Nicholas A Rattray
- Center for Health Information and Communication, Department of Veterans Affairs, Health Services Research and Development Service, Veterans Health Administration, Richard L. Roudebush VA Medical Center, CIN 13 416, Indianapolis, IN, USA
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
- Indiana University Center for Health Services and Outcomes Research, Regenstrief Institute, Inc, 1101 West 10th Street, 46202-4800, Indianapolis, IN, USA
| | - Zamal Franks
- Center for Health Information and Communication, Department of Veterans Affairs, Health Services Research and Development Service, Veterans Health Administration, Richard L. Roudebush VA Medical Center, CIN 13 416, Indianapolis, IN, USA
| | - April W Savoy
- Center for Health Information and Communication, Department of Veterans Affairs, Health Services Research and Development Service, Veterans Health Administration, Richard L. Roudebush VA Medical Center, CIN 13 416, Indianapolis, IN, USA
- Indiana University Center for Health Services and Outcomes Research, Regenstrief Institute, Inc, 1101 West 10th Street, 46202-4800, Indianapolis, IN, USA
- Purdue School of Engineering and Technology, Indiana University-Purdue University Indianapolis, Indianapolis, IN, USA
| | - Joy L Lee
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Richard M Frankel
- Center for Health Information and Communication, Department of Veterans Affairs, Health Services Research and Development Service, Veterans Health Administration, Richard L. Roudebush VA Medical Center, CIN 13 416, Indianapolis, IN, USA
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
- Indiana University Center for Health Services and Outcomes Research, Regenstrief Institute, Inc, 1101 West 10th Street, 46202-4800, Indianapolis, IN, USA
| |
Collapse
|
8
|
Wu Y, Wu M, Wang C, Lin J, Liu J, Liu S. Evaluating the Prevalence of Burnout Among Health Care Professionals Related to Electronic Health Record Use: Systematic Review and Meta-Analysis. JMIR Med Inform 2024; 12:e54811. [PMID: 38865188 PMCID: PMC11208837 DOI: 10.2196/54811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 02/23/2024] [Accepted: 04/17/2024] [Indexed: 06/13/2024] Open
Abstract
BACKGROUND Burnout among health care professionals is a significant concern, with detrimental effects on health care service quality and patient outcomes. The use of the electronic health record (EHR) system has been identified as a significant contributor to burnout among health care professionals. OBJECTIVE This systematic review and meta-analysis aims to assess the prevalence of burnout among health care professionals associated with the use of the EHR system, thereby providing evidence to improve health information systems and develop strategies to measure and mitigate burnout. METHODS We conducted a comprehensive search of the PubMed, Embase, and Web of Science databases for English-language peer-reviewed articles published between January 1, 2009, and December 31, 2022. Two independent reviewers applied inclusion and exclusion criteria, and study quality was assessed using the Joanna Briggs Institute checklist and the Newcastle-Ottawa Scale. Meta-analyses were performed using R (version 4.1.3; R Foundation for Statistical Computing), with EndNote X7 (Clarivate) for reference management. RESULTS The review included 32 cross-sectional studies and 5 case-control studies with a total of 66,556 participants, mainly physicians and registered nurses. The pooled prevalence of burnout among health care professionals in cross-sectional studies was 40.4% (95% CI 37.5%-43.2%). Case-control studies indicated a higher likelihood of burnout among health care professionals who spent more time on EHR-related tasks outside work (odds ratio 2.43, 95% CI 2.31-2.57). CONCLUSIONS The findings highlight the association between the increased use of the EHR system and burnout among health care professionals. Potential solutions include optimizing EHR systems, implementing automated dictation or note-taking, employing scribes to reduce documentation burden, and leveraging artificial intelligence to enhance EHR system efficiency and reduce the risk of burnout. TRIAL REGISTRATION PROSPERO International Prospective Register of Systematic Reviews CRD42021281173; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021281173.
Collapse
Affiliation(s)
- Yuxuan Wu
- Department of Medical Informatics, West China Hospital, Sichuan University, Chengdu, China
| | - Mingyue Wu
- Information Center, West China Hospital, Sichuan University, Chengdu, China
| | - Changyu Wang
- West China College of Stomatology, Sichuan University, Chengdu, China
| | - Jie Lin
- Department of Oral Implantology, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Jialin Liu
- Department of Medical Informatics, West China Hospital, Sichuan University, Chengdu, China
- Information Center, West China Hospital, Sichuan University, Chengdu, China
| | - Siru Liu
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, United States
| |
Collapse
|
9
|
Chiodo CP, Striano BM, Parker E, Smith JT, Bluman EM, Martin EA, Greco JM, Healey MJ. Primary Care Physician Preferences Regarding Communication from Orthopaedic Surgeons. J Bone Joint Surg Am 2024; 106:760-766. [PMID: 38386720 DOI: 10.2106/jbjs.23.00836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/24/2024]
Abstract
BACKGROUND Musculoskeletal consultations constitute a growing portion of primary care physician (PCP) referrals. Optimizing communication between PCPs and orthopaedists can potentially reduce time spent in the electronic medical record (EMR) as well as physician burnout. Little is known about the preferences of PCPs regarding communication from orthopaedic surgeons. Hence, the present study investigated, across a large health network, the preferences of PCPs regarding communication from orthopaedists. METHODS A total of 175 PCPs across 15 practices within our health network were surveyed. These providers universally utilized Epic as their EMR platform. Five-point, labeled Likert scales were utilized to assess the PCP-perceived importance of communication from orthopaedists in specific clinical scenarios. PCPs were further asked to report their preferred method of communication in each scenario and their overall interest in communication from orthopaedists. Logistic regression analyses were performed to determine whether any PCP characteristics were associated with the preferred method of communication and the overall PCP interest in communication from orthopaedists. RESULTS A total of 107 PCPs (61.1%) responded to the survey. PCPs most commonly rated communication from orthopaedists as highly important in the scenario of an orthopaedist needing information from the PCP. In this scenario, PCPs preferred to receive an Epic Staff Message. Scenarios involving a recommendation for surgery, hospitalization, or a major clinical change were also rated as highly important. In these scenarios, an Epic CC'd Chart rather than a Staff Message was preferred. Increased after-hours EMR use was associated with diminished odds of having a high interest in communication from orthopaedists (odds ratio, 0.65; 95% confidence interval, 0.48 to 0.88; p = 0.005). Ninety-three PCPs (86.9%) reported spending 1 to 1.5 hours or more per day in Epic after normal clinical hours, and 27 (25.2%) spent >3 hours per day. Forty-six PCPs (43.0%) reported experiencing ≥1 symptom of burnout. CONCLUSIONS There were distinct preferences among PCPs regarding clinical communication from orthopaedic surgeons. There was also evidence of substantial burnout and after-hours work effort by PCPs. These results may help to optimize communication between PCPs and orthopaedists while reducing the amount of time that PCPs spend in the EMR.
Collapse
Affiliation(s)
- Christopher P Chiodo
- Foot and Ankle Division, Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, Massachusetts
| | - Brendan M Striano
- Harvard Combined Orthopaedic Residency Program, Boston, Massachusetts
| | - Emily Parker
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, Massachusetts
| | - Jeremy T Smith
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - Eric M Bluman
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - Elizabeth A Martin
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - Julia M Greco
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, Massachusetts
| | - Michael J Healey
- Harvard Medical School, Boston, Massachusetts
- Department of Internal Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| |
Collapse
|
10
|
Owens LM, Wilda JJ, Hahn PY, Koehler T, Fletcher JJ. The association between use of ambient voice technology documentation during primary care patient encounters, documentation burden, and provider burnout. Fam Pract 2024; 41:86-91. [PMID: 37672297 DOI: 10.1093/fampra/cmad092] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/07/2023] Open
Abstract
BACKGROUND The burden of documentation in the electronic medical record has been cited as a major factor in provider burnout. The aim of this study was to evaluate the association between ambient voice technology, coupled with natural language processing and artificial intelligence (DAX™), on primary care provider documentation burden and burnout. METHODS An observational study of 110 primary care providers within a community teaching health system. The primary objectives were to determine the association between DAX™ usage and provider burnout scores on the Oldenburg Burnout Inventory (OLBI) as well as the effect on documentation time per patient encounter (minutes). RESULTS The completion rate for the survey was 75% (83/110) and high DAX™ use (>60% of encounters) was seen in 28% of providers (23/83). High DAX™ use was associated with significantly less burnout on the OLBI disengagement sub-score (MD [Mean Difference] -2.1; 95% confidence interval [CI] -3.8 to -0.4) but not the OLBI disengagement sub-score (-1.0; 95% CI -2.9 to 1.0) or total score (MD -3.0; 95% CI -6.4 to 0.3). Nineteen providers with high implementation of DAX™ had pre and postimplementation data on documentation time per encounter. After DAX™ implementation average documentation time in notes per encounter was significantly reduced by 28.8% (1.8 min; 95% CI 1.4-2.2). CONCLUSIONS The use of ambient voice technology during patient encounters was associated with significantly reduced documentation burden and primary care provider disengagement but not total provider burnout scores.
Collapse
Affiliation(s)
- Lance M Owens
- Department of Primary Care, University of Michigan Health West, Grand Rapids, MI, United States
| | - Joshua J Wilda
- Information Technology, University of Michigan Health West, Grand Rapids, MI, United States
| | - Peter Y Hahn
- Department of Clinical Research, University of Michigan Health West, Grand Rapids, MI, United States
| | - Tracy Koehler
- Department of Clinical Research, University of Michigan Health West, Grand Rapids, MI, United States
| | - Jeffrey J Fletcher
- Department of Clinical Research, University of Michigan Health West, Grand Rapids, MI, United States
| |
Collapse
|
11
|
Williams CY, Bains J, Tang T, Patel K, Lucas AN, Chen F, Miao BY, Butte AJ, Kornblith AE. Evaluating Large Language Models for Drafting Emergency Department Discharge Summaries. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.04.03.24305088. [PMID: 38633805 PMCID: PMC11023681 DOI: 10.1101/2024.04.03.24305088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/19/2024]
Abstract
Importance Large language models (LLMs) possess a range of capabilities which may be applied to the clinical domain, including text summarization. As ambient artificial intelligence scribes and other LLM-based tools begin to be deployed within healthcare settings, rigorous evaluations of the accuracy of these technologies are urgently needed. Objective To investigate the performance of GPT-4 and GPT-3.5-turbo in generating Emergency Department (ED) discharge summaries and evaluate the prevalence and type of errors across each section of the discharge summary. Design Cross-sectional study. Setting University of California, San Francisco ED. Participants We identified all adult ED visits from 2012 to 2023 with an ED clinician note. We randomly selected a sample of 100 ED visits for GPT-summarization. Exposure We investigate the potential of two state-of-the-art LLMs, GPT-4 and GPT-3.5-turbo, to summarize the full ED clinician note into a discharge summary. Main Outcomes and Measures GPT-3.5-turbo and GPT-4-generated discharge summaries were evaluated by two independent Emergency Medicine physician reviewers across three evaluation criteria: 1) Inaccuracy of GPT-summarized information; 2) Hallucination of information; 3) Omission of relevant clinical information. On identifying each error, reviewers were additionally asked to provide a brief explanation for their reasoning, which was manually classified into subgroups of errors. Results From 202,059 eligible ED visits, we randomly sampled 100 for GPT-generated summarization and then expert-driven evaluation. In total, 33% of summaries generated by GPT-4 and 10% of those generated by GPT-3.5-turbo were entirely error-free across all evaluated domains. Summaries generated by GPT-4 were mostly accurate, with inaccuracies found in only 10% of cases, however, 42% of the summaries exhibited hallucinations and 47% omitted clinically relevant information. Inaccuracies and hallucinations were most commonly found in the Plan sections of GPT-generated summaries, while clinical omissions were concentrated in text describing patients' Physical Examination findings or History of Presenting Complaint. Conclusions and Relevance In this cross-sectional study of 100 ED encounters, we found that LLMs could generate accurate discharge summaries, but were liable to hallucination and omission of clinically relevant information. A comprehensive understanding of the location and type of errors found in GPT-generated clinical text is important to facilitate clinician review of such content and prevent patient harm.
Collapse
Affiliation(s)
| | - Jaskaran Bains
- Department of Emergency Medicine; University of California, San Francisco
| | - Tianyu Tang
- Department of Emergency Medicine; University of California, San Francisco
| | - Kishan Patel
- Department of Emergency Medicine; University of California, San Francisco
| | - Alexa N. Lucas
- Department of Emergency Medicine; University of California, San Francisco
| | - Fiona Chen
- Department of Emergency Medicine; University of California, San Francisco
| | - Brenda Y. Miao
- Bakar Computational Health Sciences Institute; University of California, San Francisco
| | - Atul J. Butte
- Bakar Computational Health Sciences Institute; University of California, San Francisco
| | - Aaron E. Kornblith
- Bakar Computational Health Sciences Institute; University of California, San Francisco
- Department of Emergency Medicine; University of California, San Francisco
| |
Collapse
|
12
|
Webber S, Semia S, Nacht CL, Garcia S, Kloster H, Vellardita L, Kieren MQ, Kelly MM. Physician Work-Personal Intersection: A Scoping Review of Terms, Definitions, and Measures. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2024; 99:331-339. [PMID: 38039978 DOI: 10.1097/acm.0000000000005579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/03/2023]
Abstract
PURPOSE A substantial body of evidence describes the multidimensional relationship between the intersection of physicians' work and personal lives and health care quality and costs, workforce sustainability, and workplace safety culture. However, there is no clear consensus on the terms, definitions, or measures used in physician work-personal intersection (WPI) research. In this scoping review, the authors aimed to describe the terms and definitions used by researchers to describe physician WPI, summarize the measurement tools used, and formulate a conceptual model of WPI that can inform future research. METHOD The authors searched PubMed, CINAHL, Scopus, and Web of Science for studies that investigated U.S. practicing physicians' WPI and measured WPI as an outcome from January 1990 to March 2022. The authors applied thematic analysis to all WPI terms, definitions, and survey questions or prompts in the included studies to create a conceptual model of physician WPI. RESULTS Ultimately, 102 studies were included in the final analysis. The most commonly used WPI terms were work-life balance, work-life integration, and work-home or work-life conflict(s). There was no consistency in the definition of any terms across studies. There was heterogeneity in the way WPI was measured, and only 8 (7.8%) studies used a validated measurement tool. The authors identified 6 key driver domains of WPI: work and personal demands; colleague and institutional support and resources; personal identity, roles, health, and values; work schedule and flexibility; partner and family support; and personal and professional strategies. CONCLUSIONS The authors found significant variability in the terms, definitions, and measures used to study physician WPI. They offer a conceptual model of the WPI construct that can be used to more consistently study physician WPI in the future. Future work should further investigate the validity of this model and generate consensus around WPI terms, definitions, and measures.
Collapse
|
13
|
Seo JH, Bae HO. Job stress and burnout affecting the mental health of Korean medical faculty members: constructing causality among latent variables. KOREAN JOURNAL OF MEDICAL EDUCATION 2024; 36:27-39. [PMID: 38462240 PMCID: PMC10925813 DOI: 10.3946/kjme.2024.282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 10/23/2023] [Accepted: 01/09/2024] [Indexed: 03/12/2024]
Abstract
PURPOSE This study aims to examine whether perceived levels of job stress, burnout, and mental health are different according to demographic characteristics and working conditions and to investigate the direct and indirect effects of job stress and burnout on the mental health of medical faculty members. METHODS The study sample consists of 855 faculty members in 40 medical schools nationwide in the 2020 Burnout of Faculty Members of Medical Schools in Korea data with a grant from the Korean Association of Medical Colleges. This study employed structural equation modeling to construct causality among latent variables in addition to t-test, analysis of variance, and correlation coefficients for bivariate analyses. RESULTS Perceived job stress, burnout, and mental health levels of medical faculty members showed significant group differences by demographic characteristics and working conditions. Job stress directly affected mental health (β=0.215, p<0.01) and indirectly affected mental health via burnout (β=0.493, p<0.001). Thus burnout significantly mediated the relationship between job stress and the mental health of medical faculty members. CONCLUSION This study found that job stress has direct and indirect effects on the mental health of medical faculty members, and burnout partially mediated this relationship. Further studies need to intervene in job stress and burnout to prevent the adverse mental health of medical faculty members and to introduce proper measures to improve working conditions affecting job stress and burnout.
Collapse
Affiliation(s)
- Ji-Hyun Seo
- Department of Pediatrics and Medical Education, Gyeongsang National University Hospital, Gyeongsang Institute of Health Sciences, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Hwa-ok Bae
- Department of Social Welfare, Gyeongsang National University College of Social Sciences, Jinju, Korea
| |
Collapse
|
14
|
Funk KA, Stillman M, Wang Q, Manser ST, Rogers EA. Association of Burnout With Primary Care Clinician Perception of Team-Based Scheduling Support. J Prim Care Community Health 2024; 15:21501319231222372. [PMID: 38361419 PMCID: PMC10874136 DOI: 10.1177/21501319231222372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 11/17/2023] [Accepted: 12/02/2023] [Indexed: 02/17/2024] Open
Abstract
INTRODUCTION Primary care clinician burnout is pervasive and detrimental. How components of teamwork and clinic culture might contribute to burnout remains unsettled. OBJECTIVE To examine associations between primary care clinician perceptions of specific components of teamwork and of organizational culture, and perceived stress and burnout. METHODS Cross-sectional survey study of primary care clinicians from 5 county health system clinics. Measures: Perceptions of teamwork related to coordination of care, and clinic provision of chronic disease self-management support; values alignment and workplace equity; and demographics. DATA ANALYSIS Descriptive statistics and Spearman's correlations to examine associations, controlling for clinic and examining response variability by clinic. RESULTS Of 72 clinicians, 64% were female and 32% non-white. About 56% had worked at least 4 years and half worked 5 to 6 half days/week or more in their clinic. Clinicians who reported having someone on the clinician's care team routinely schedule follow-up appointments for patients with complex chronic illnesses reported lower stress and burnout. Those who perceived greater values alignment with their clinic and greater personal and employee equitable treatment had lower stress and burnout. CONCLUSIONS Teamwork among clinicians and non-clinical staff, a component of teamwork that is not well-considered in current literature, could be an important piece of the puzzle to decrease the persistent and challenging issue of stress and burnout among primary care clinicians.
Collapse
Affiliation(s)
- Kylee A. Funk
- University of Minnesota College of Pharmacy, Department of Pharmaceutical Care and Health Systems, Minneapolis, MN, USA
| | - Martin Stillman
- Hennepin Healthcare, Minneapolis, MN, USA
- University of Minnesota Medical School, Department of Medicine, Minneapolis, MN, USA
| | - Qi Wang
- University of Minnesota Clinical and Translational Science Institute, Minneapolis, MN, USA
| | - Sarah Turcotte Manser
- University of Minnesota Medical School, Department of Medicine, Minneapolis, MN, USA
| | - Elizabeth A. Rogers
- University of Minnesota Medical School, Department of Medicine, Minneapolis, MN, USA
| |
Collapse
|
15
|
Khavandi S, Zaghloul F, Higham A, Lim E, de Pennington N, Celi LA. Investigating the Impact of Automation on the Health Care Workforce Through Autonomous Telemedicine in the Cataract Pathway: Protocol for a Multicenter Study. JMIR Res Protoc 2023; 12:e49374. [PMID: 38051569 PMCID: PMC10731565 DOI: 10.2196/49374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 09/17/2023] [Accepted: 09/18/2023] [Indexed: 12/07/2023] Open
Abstract
BACKGROUND While digital health innovations are increasingly being adopted by health care organizations, implementation is often carried out without considering the impacts on frontline staff who will be using the technology and who will be affected by its introduction. The enthusiasm surrounding the use of artificial intelligence (AI)-enabled digital solutions in health care is tempered by uncertainty around how it will change the working lives and practices of health care professionals. Digital enablement can be viewed as facilitating enhanced effectiveness and efficiency by improving services and automating cognitive labor, yet the implementation of such AI technology comes with challenges related to changes in work practices brought by automation. This research explores staff experiences before and after care pathway automation with an autonomous clinical conversational assistant, Dora (Ufonia Ltd), that is able to automate routine clinical conversations. OBJECTIVE The primary objective is to examine the impact of AI-enabled automation on clinicians, allied health professionals, and administrators who provide or facilitate health care to patients in high-volume, low-complexity care pathways. In the process of transforming care pathways through automation of routine tasks, staff will increasingly "work at the top of their license." The impact of this fundamental change on the professional identity, well-being, and work practices of the individual is poorly understood at present. METHODS We will adopt a multiple case study approach, combining qualitative and quantitative data collection methods, over 2 distinct phases, namely phase A (preimplementation) and phase B (postimplementation). RESULTS The analysis is expected to reveal the interrelationship between Dora and those affected by its introduction. This will reveal how tasks and responsibilities have changed or shifted, current tensions and contradictions, ways of working, and challenges, benefits, and opportunities as perceived by those on the frontlines of the health care system. The findings will enable a better understanding of the resistance or susceptibility of different stakeholders within the health care workforce and encourage managerial awareness of differing needs, demands, and uncertainties. CONCLUSIONS The implementation of AI in the health care sector, as well as the body of research on this topic, remain in their infancy. The project's key contribution will be to understand the impact of AI-enabled automation on the health care workforce and their work practices. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/49374.
Collapse
Affiliation(s)
- Sarah Khavandi
- Ufonia, Oxford, United Kingdom
- Gloucestershire Hospitals NHS Foundation Trust, Cheltenham, United Kingdom
- Imperial College School of Medicine, Imperial College London, London, United Kingdom
| | - Fatema Zaghloul
- Operations and Management Science, Healthcare and Innovation, University of Bristol, Bristol, United Kingdom
| | - Aisling Higham
- Ufonia, Oxford, United Kingdom
- Royal Berkshire NHS Foundation Trust, Reading, United Kingdom
| | - Ernest Lim
- Ufonia, Oxford, United Kingdom
- Department of Computer Science, University of York, York, United Kingdom
| | | | - Leo Anthony Celi
- Laboratory for Computational Physiology, Massachusetts Institute of Technology, Cambridge, MA, United States
- Division of Pulmonary, Critical Care and Sleep Medicine, Beth Israel Deaconess Medical Center, Boston, MA, United States
- Department of Biostatistics, Harvard TH Chan School of Public Health, Boston, MA, United States
| |
Collapse
|
16
|
Looi JCL, Kisely S, Allison S, Bastiampillai T, Maguire PA. The unfulfilled promises of electronic health records. AUST HEALTH REV 2023; 47:744-746. [PMID: 37866822 DOI: 10.1071/ah23192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Accepted: 10/05/2023] [Indexed: 10/24/2023]
Abstract
We provide a brief update on the current evidence on electronic health records' benefits, risks, and potential harms through a rapid narrative review. Many of the promised benefits of electronic health records have not yet been realised. Electronic health records are often not user-friendly. To enhance their potential, electronic health record platforms should be continuously evaluated and enhanced by carefully considering feedback from all stakeholders.
Collapse
Affiliation(s)
- Jeffrey C L Looi
- Academic Unit of Psychiatry and Addiction Medicine, The Australian National University School of Medicine and Psychology, Canberra Hospital, Building 4, Level 2, PO Box 11, Canberra, ACT 2605, Australia; and Consortium of Australian-Academic Psychiatrists for Independent Policy and Research Analysis (CAPIPRA), Canberra, ACT, Australia
| | - Steve Kisely
- Consortium of Australian-Academic Psychiatrists for Independent Policy and Research Analysis (CAPIPRA), Canberra, ACT, Australia; and School of Medicine, The University of Queensland, Princess Alexandra Hospital, Ipswich Road, Woolloongabba, Brisbane, Qld, Australia; and Departments of Psychiatry, Community Health and Epidemiology, Dalhousie University, Halifax, NS, Canada
| | - Stephen Allison
- Consortium of Australian-Academic Psychiatrists for Independent Policy and Research Analysis (CAPIPRA), Canberra, ACT, Australia; and College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
| | - Tarun Bastiampillai
- Consortium of Australian-Academic Psychiatrists for Independent Policy and Research Analysis (CAPIPRA), Canberra, ACT, Australia; and College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia; and Department of Psychiatry, Monash University, Wellington Road, Clayton, Vic., Australia
| | - Paul A Maguire
- Academic Unit of Psychiatry and Addiction Medicine, The Australian National University School of Medicine and Psychology, Canberra Hospital, Building 4, Level 2, PO Box 11, Canberra, ACT 2605, Australia; and Consortium of Australian-Academic Psychiatrists for Independent Policy and Research Analysis (CAPIPRA), Canberra, ACT, Australia
| |
Collapse
|
17
|
Payne TH, Turner GK. I'm not burned out. This is how I write notes. JAMIA Open 2023; 6:ooad099. [PMID: 38033784 PMCID: PMC10684266 DOI: 10.1093/jamiaopen/ooad099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 09/27/2023] [Accepted: 11/13/2023] [Indexed: 12/02/2023] Open
Abstract
Objectives We describe an automated transcription system that addresses many documentation problems and fits within scheduled clinical hours. Materials and methods During visits, the provider listens to the patient while maintaining eye contact and making brief notes on paper. Immediately after the visit conclusion and before the next, the provider makes a short voice recording on a smartphone which is transmitted to the system. The system uses a public domain general language model, and a hypertuned provider-specific language model that is iteratively refined as each produced note is edited by the physician, followed by final automated processing steps to add any templated text to the note. Results The provider leaves the clinic having completed all voice files, median duration 3.4 minutes. Created notes are formatted as preferred and are a median of 363 words (range 125-1175). Discussion This approach permits documentation to occur almost entirely within scheduled clinic hours, without copy-forward errors, and without interference with patient-provider interaction. Conclusion Though no documentation method is likely to appeal to all, this approach may appeal to many physicians and avoid many current problems with documentation.
Collapse
Affiliation(s)
- Thomas H Payne
- Department of Medicine, University of Washington School of Medicine, Seattle, WA 98104-2499, United States
- Department of Biomedical Informatics & Medical Education, University of Washington School of Medicine, Seattle, WA 98104-2499, United States
| | - Grace K Turner
- Department of Biomedical Informatics & Medical Education, University of Washington School of Medicine, Seattle, WA 98104-2499, United States
| |
Collapse
|
18
|
Rotenstein LS, Holmgren AJ, Horn DM, Lipsitz S, Phillips R, Gitomer R, Bates DW. System-Level Factors and Time Spent on Electronic Health Records by Primary Care Physicians. JAMA Netw Open 2023; 6:e2344713. [PMID: 37991757 PMCID: PMC10665969 DOI: 10.1001/jamanetworkopen.2023.44713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 10/13/2023] [Indexed: 11/23/2023] Open
Abstract
Importance Primary care physicians (PCPs) spend the most time on the electronic health record (EHR) of any specialty. Thus, it is critical to understand what factors contribute to varying levels of PCP time spent on EHRs. Objective To characterize variation in EHR time across PCPs and primary care clinics, and to describe how specific PCP, patient panel, clinic, and team collaboration factors are associated with PCPs' time spent on EHRs. Design, Setting, and Participants This cross-sectional study included 307 PCPs practicing across 31 primary care clinics at Massachusetts General Hospital and Brigham and Women's Hospital during 2021. Data were analyzed from October 2022 to October 2023. Main Outcomes and Measures Total per-visit EHR time, total per-visit pajama time (ie, time spent on the EHR between 5:30 pm to 7:00 am and on weekends), and total per-visit time on the electronic inbox as measured by activity log data derived from an EHR database. Results The sample included 307 PCPs (183 [59.6%] female). On a per-visit basis, PCPs spent a median (IQR) of 36.2 (28.9-45.7) total minutes on the EHR, 6.2 (3.1-11.5) minutes of pajama time, and 7.8 (5.5-10.7) minutes on the electronic inbox. When comparing PCP time expenditure by clinic, median (IQR) total EHR time, median (IQR) pajama time, and median (IQR) electronic inbox time ranged from 23.5 (20.7-53.1) to 47.9 (30.6-70.7) minutes per visit, 1.7 (0.7-10.5) to 13.1 (7.7-28.2) minutes per visit, and 4.7 (4.1-5.2) to 10.8 (8.9-15.2) minutes per visit, respectively. In a multivariable model with an outcome of total per-visit EHR time per visit, an above median percentage of teamwork on orders was associated with 3.81 (95% CI, 0.49-7.13) minutes per visit fewer and having a clinic pharmacy technician was associated with 7.87 (95% CI, 2.03-13.72) minutes per visit fewer. Practicing in a community health center was associated with fewer minutes of total EHR time per visit (5.40 [95% CI, 0.06-10.74] minutes). Conclusions and Relevance There is substantial variation in EHR time among individual PCPs and PCPs within clinics. Organization-level factors, such as team collaboration on orders, support for medication refill functions, and practicing in a community health center, are associated with lower EHR time for PCPs. These findings highlight the importance of addressing EHR burden at a systems level.
Collapse
Affiliation(s)
- Lisa S Rotenstein
- Brigham and Women's Hospital, Boston, Massachusetts
- University of California at San Francisco
| | | | - Daniel M Horn
- Harvard Medical School, Boston, Massachusetts
- Massachusetts General Hospital, Boston
| | - Stuart Lipsitz
- Brigham and Women's Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - Russell Phillips
- Harvard Medical School, Boston, Massachusetts
- Harvard Center for Primary Care, Boston, Massachusetts
| | - Richard Gitomer
- Brigham and Women's Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - David W Bates
- Brigham and Women's Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| |
Collapse
|
19
|
Lee J, Patel S, Taxter A. How to make the electronic health record your friend. Curr Opin Pediatr 2023; 35:579-584. [PMID: 37233610 DOI: 10.1097/mop.0000000000001261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
PURPOSE OF REVIEW The electronic health record (EHR) has become ubiquitous among healthcare providers. It has revolutionized how we care for patients allowing for instant access to records, improved order entry, and improved patient outcomes. However, it has also been implicated as a source of stress, burnout, and workplace dissatisfaction among its users. The article provides an overview of factors associated with burnout focusing on the pediatrician and pediatric subspecialist workflows and will summarize practical tips based on clinical informatics principles for addressing these factors. RECENT FINDINGS Several metrics related to EHR including training, efficiency and lack of usability have been cited as factors associated with burnout. Organizational, personal, and interpersonal factors as well as work culture are more associated with burnout than EHR use. SUMMARY Organizational strategies to address burnout include first monitoring metrics including physician satisfaction and wellbeing, incorporating mindfulness and teamwork, and decreasing stress from the EHR by providing training, standardized workflows, and efficiency tools. All clinicians should feel empowered to customize workflows and seek organizational help for improving EHR use.
Collapse
Affiliation(s)
- Jennifer Lee
- Department of Pediatrics
- Department of Biomedical Informatics, The Ohio State University College of Medicine, Columbus
- Division of Clinical Informatics
- Division of Gastroenterology
| | - Shama Patel
- Department of Pediatrics
- Division of Clinical Informatics
- Division of Neonatology
| | - Alysha Taxter
- Department of Pediatrics
- Division of Clinical Informatics
- Division of Rheumatology, Nationwide Children's Hospital, Columbus, Ohio, USA
| |
Collapse
|
20
|
Hendrix N, Bazemore A, Holmgren AJ, Rotenstein LS, Eden AR, Krist AH, Phillips RL. Variation in Family Physicians' Experiences Across Different Electronic Health Record Platforms: a Descriptive Study. J Gen Intern Med 2023; 38:2980-2987. [PMID: 36952084 PMCID: PMC10035476 DOI: 10.1007/s11606-023-08169-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 03/10/2023] [Indexed: 03/24/2023]
Abstract
BACKGROUND Electronic health records (EHRs) have been connected to excessive workload and physician burnout. Little is known about variation in physician experience with different EHRs, however. OBJECTIVE To analyze variation in reported usability and satisfaction across EHRs. DESIGN Internet-based survey available between December 2021 and October 2022 integrated into American Board of Family Medicine (ABFM) certification process. PARTICIPANTS ABFM-certified family physicians who use an EHR with at least 50 total responding physicians. MEASUREMENTS Self-reported experience of EHR usability and satisfaction. KEY RESULTS We analyzed the responses of 3358 physicians who used one of nine EHRs. Epic, athenahealth, and Practice Fusion were rated significantly higher across six measures of usability. Overall, between 10 and 30% reported being very satisfied with their EHR, and another 32 to 40% report being somewhat satisfied. Physicians who use athenahealth or Epic were most likely to be very satisfied, while physicians using Allscripts, Cerner, or Greenway were the least likely to be very satisfied. EHR-specific factors were the greatest overall influence on variation in satisfaction: they explained 48% of variation in the probability of being very satisfied with Epic, 46% with eClinical Works, 14% with athenahealth, and 49% with Cerner. CONCLUSIONS Meaningful differences exist in physician-reported usability and overall satisfaction with EHRs, largely explained by EHR-specific factors. User-centric design and implementation, and robust ongoing evaluation are needed to reduce physician burden and ensure excellent experience with EHRs.
Collapse
Affiliation(s)
- Nathaniel Hendrix
- American Board of Family Medicine, Lexington, KY, USA.
- Center for Professionalism and Value in Health Care, Washington, DC, USA.
| | - Andrew Bazemore
- American Board of Family Medicine, Lexington, KY, USA
- Center for Professionalism and Value in Health Care, Washington, DC, USA
| | - A Jay Holmgren
- University of California, San Francisco, San Francisco, CA, USA
| | - Lisa S Rotenstein
- Brigham and Women's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Aimee R Eden
- Agency for Healthcare Research and Quality, Rockville, MD, USA
| | - Alex H Krist
- Virginia Commonwealth University, Richmond, VA, USA
| | - Robert L Phillips
- American Board of Family Medicine, Lexington, KY, USA
- Center for Professionalism and Value in Health Care, Washington, DC, USA
| |
Collapse
|
21
|
Rotenstein L, Jay Holmgren A. COVID exacerbated the gender disparity in physician electronic health record inbox burden. J Am Med Inform Assoc 2023; 30:1720-1724. [PMID: 37436709 PMCID: PMC10531114 DOI: 10.1093/jamia/ocad141] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 06/19/2023] [Accepted: 07/18/2023] [Indexed: 07/13/2023] Open
Abstract
The COVID-19 pandemic was associated with significant changes to the delivery of ambulatory care, including a dramatic increase in patient messages to physicians. While asynchronous messaging is a valuable communication modality for patients, a greater volume of patient messages is associated with burnout and decreased well-being for physicians. Given that women physicians experienced greater electronic health record (EHR) burden and received more patient messages pre-pandemic, there is concern that COVID may have exacerbated this disparity. Using EHR audit log data of ambulatory physicians at an academic medical center, we used a difference-in-differences framework to evaluate the impact of the pandemic on patient message volume and compare differences between men and women physicians. We found patient message volume increased post-COVID for all physicians, and women physicians saw an additional increase compared to men. Our results contribute to the growing evidence of different communication expectations for women physicians that contribute to the gender disparity in EHR burden.
Collapse
Affiliation(s)
- Lisa Rotenstein
- Department of Medicine, Brigham & Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - A Jay Holmgren
- Division of Clinical Informatics and Digital Transformation (DoC-IT), University of California San Francisco, San Francisco, California, USA
| |
Collapse
|
22
|
Otsuka Y, Hagiya H, Sunada N, Otsuka F. Task shifting of medical office works: A preliminary questionnaire survey for generalists. J Gen Fam Med 2023; 24:317-319. [PMID: 37727622 PMCID: PMC10506393 DOI: 10.1002/jgf2.641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 07/02/2023] [Accepted: 07/13/2023] [Indexed: 09/21/2023] Open
Abstract
To reduce physician burden, task shifting of clerical work from physicians to medical assistants is being promoted; however, it depends on hospitals. A questionnaire survey was conducted among 40 general physicians at Okayama University Hospital in December 2022 to investigate physicians' preferences toward task shifting. Compared to other tasks, most physicians thought that ordering examinations (14, 47%), replying to referral letters (19, 63%), and prescriptions (21, 70%) and medical record entries (22, 73%) should not be task shifted. Physicians' controversial opinions on task shifting maybe the reason behind the slow progress in task shifting.
Collapse
Affiliation(s)
- Yuki Otsuka
- Department of General MedicineOkayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesOkayamaJapan
| | - Hideharu Hagiya
- Department of General MedicineOkayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesOkayamaJapan
| | - Naruhiko Sunada
- Department of General MedicineOkayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesOkayamaJapan
| | - Fumio Otsuka
- Department of General MedicineOkayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesOkayamaJapan
| |
Collapse
|
23
|
Lou SS, Baratta LR, Lew D, Harford D, Avidan MS, Kannampallil T. Anesthesia Clinical Workload Estimated From Electronic Health Record Documentation vs Billed Relative Value Units. JAMA Netw Open 2023; 6:e2328514. [PMID: 37566415 PMCID: PMC10422189 DOI: 10.1001/jamanetworkopen.2023.28514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 07/03/2023] [Indexed: 08/12/2023] Open
Abstract
Importance Accurate measurements of clinical workload are needed to inform health care policy. Existing methods for measuring clinical workload rely on surveys or time-motion studies, which are labor-intensive to collect and subject to biases. Objective To compare anesthesia clinical workload estimated from electronic health record (EHR) audit log data vs billed relative value units. Design, Setting, and Participants This cross-sectional study of anesthetic encounters occurring between August 26, 2019, and February 9, 2020, used data from 8 academic hospitals, community hospitals, and surgical centers across Missouri and Illinois. Clinicians who provided anesthetic services for at least 1 surgical encounter were included. Data were analyzed from January 2022 to January 2023. Exposure Anesthetic encounters associated with a surgical procedure were included. Encounters associated with labor analgesia and endoscopy were excluded. Main Outcomes and Measures For each encounter, EHR-derived clinical workload was estimated as the sum of all EHR actions recorded in the audit log by anesthesia clinicians who provided care. Billing-derived clinical workload was measured as the total number of units billed for the encounter. A linear mixed-effects model was used to estimate the relative contribution of patient complexity (American Society of Anesthesiology [ASA] physical status modifier), procedure complexity (ASA base unit value for the procedure), and anesthetic duration (time units) to EHR-derived and billing-derived workload. The resulting β coefficients were interpreted as the expected effect of a 1-unit change in each independent variable on the standardized workload outcome. The analysis plan was developed after the data were obtained. Results A total of 405 clinicians who provided anesthesia for 31 688 encounters were included in the study. A total of 8 288 132 audit log actions corresponding to 39 131 hours of EHR use were used to measure EHR-derived workload. The contributions of patient complexity, procedural complexity, and anesthesia duration to EHR-derived workload differed significantly from their contributions to billing-derived workload. The contribution of patient complexity toward EHR-derived workload (β = 0.162; 95% CI, 0.153-0.171) was more than 50% greater than its contribution toward billing-derived workload (β = 0.106; 95% CI, 0.097-0.116; P < .001). In contrast, the contribution of procedure complexity toward EHR-derived workload (β = 0.033; 95% CI, 0.031-0.035) was approximately one-third its contribution toward billing-derived workload (β = 0.106; 95% CI, 0.104-0.108; P < .001). Conclusions and Relevance In this cross-sectional study of 8 hospitals, reimbursement for anesthesiology services overcompensated for procedural complexity and undercompensated for patient complexity. This method for measuring clinical workload could be used to improve reimbursement valuations for anesthesia and other specialties.
Collapse
Affiliation(s)
- Sunny S. Lou
- Department of Anesthesiology, Washington University School of Medicine, St Louis, Missouri
- Institute for Informatics, Washington University School of Medicine, St Louis, Missouri
| | - Laura R. Baratta
- Institute for Informatics, Washington University School of Medicine, St Louis, Missouri
| | - Daphne Lew
- Division of Biostatistics, Washington University School of Medicine, St Louis, Missouri
| | - Derek Harford
- Department of Anesthesiology, Washington University School of Medicine, St Louis, Missouri
| | - Michael S. Avidan
- Department of Anesthesiology, Washington University School of Medicine, St Louis, Missouri
| | - Thomas Kannampallil
- Department of Anesthesiology, Washington University School of Medicine, St Louis, Missouri
- Institute for Informatics, Washington University School of Medicine, St Louis, Missouri
| |
Collapse
|
24
|
Iscoe MS, Loza AJ, Turbiville D, Campbell SM, Peaper DR, Balbuena-Merle RI, Hauser RG. PROSER: A Web-Based Peripheral Blood Smear Interpretation Support Tool Utilizing Electronic Health Record Data. Am J Clin Pathol 2023; 160:98-105. [PMID: 37026746 DOI: 10.1093/ajcp/aqad024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 02/10/2023] [Indexed: 04/08/2023] Open
Abstract
OBJECTIVES Peripheral blood smear (PBS) interpretation represents a cornerstone of pathology practice and resident training but has remained largely static for decades. Here, we describe a novel PBS interpretation support tool. METHODS In a mixed-methods quality improvement study, a web-based clinical decision support (CDS) tool to assist pathologists in PBS interpretation, PROSER, was deployed in an academic hospital over a 2-month period in 2022. PROSER interfaced with the hospital system's electronic health record and data warehouse to obtain and display relevant demographic, laboratory, and medication information for patients with pending PBS consults. PROSER used these data along with morphologic findings entered by the pathologist to draft a PBS interpretation using rule-based logic. We evaluated users' perceptions of PROSER with a Likert-type survey. RESULTS PROSER displayed 46 laboratory values with corresponding reference ranges and abnormal flags, allowed for entry of 14 microscopy findings, and computed 2 calculations based on laboratory values; it composed automated PBS reports using a library of 92 prewritten phrases. Overall, PROSER was well received by residents. CONCLUSIONS In this quality improvement study, we successfully deployed a web-based CDS tool for PBS interpretation. Future work is needed to quantitatively evaluate this intervention's effects on clinical outcomes and resident training.
Collapse
Affiliation(s)
- Mark S Iscoe
- Veterans Affairs Connecticut Healthcare System, West Haven, CT, US
- Department of Emergency Medicine, Yale University School of Medicine, New Haven, CT, US
| | - Andrew J Loza
- Veterans Affairs Connecticut Healthcare System, West Haven, CT, US
- Department of Laboratory Medicine, Yale University School of Medicine, New Haven, CT, US
| | - Donald Turbiville
- Veterans Affairs Connecticut Healthcare System, West Haven, CT, US
- Department of Laboratory Medicine, Yale University School of Medicine, New Haven, CT, US
| | - Sheldon M Campbell
- Veterans Affairs Connecticut Healthcare System, West Haven, CT, US
- Department of Laboratory Medicine, Yale University School of Medicine, New Haven, CT, US
| | - David R Peaper
- Veterans Affairs Connecticut Healthcare System, West Haven, CT, US
- Department of Laboratory Medicine, Yale University School of Medicine, New Haven, CT, US
| | - Raisa I Balbuena-Merle
- Veterans Affairs Connecticut Healthcare System, West Haven, CT, US
- Department of Laboratory Medicine, Yale University School of Medicine, New Haven, CT, US
| | - Ronald G Hauser
- Veterans Affairs Connecticut Healthcare System, West Haven, CT, US
- Department of Laboratory Medicine, Yale University School of Medicine, New Haven, CT, US
| |
Collapse
|
25
|
Rotenstein LS, Apathy N, Holmgren AJ, Bates DW. Physician Note Composition Patterns and Time on the EHR Across Specialty Types: a National, Cross-sectional Study. J Gen Intern Med 2023; 38:1119-1126. [PMID: 36418647 PMCID: PMC10110827 DOI: 10.1007/s11606-022-07834-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 09/29/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND The burden of clinical documentation in electronic health records (EHRs) has been associated with physician burnout. Numerous tools (e.g., note templates and dictation services) exist to ease documentation burden, but little evidence exists regarding how physicians use these tools in combination and the degree to which these strategies correlate with reduced time spent on documentation. OBJECTIVE To characterize EHR note composition strategies, how these strategies differ in time spent on notes and the EHR, and their distribution across specialty types. DESIGN Secondary analysis of physician-level measures of note composition and EHR use derived from Epic Systems' Signal data warehouse. We used k-means clustering to identify documentation strategies, and ordinary least squares regression to analyze the relationship between documentation strategies and physician time spent in the EHR, on notes, and outside scheduled hours. PARTICIPANTS A total of 215,207 US-based ambulatory physicians using the Epic EHR between September 2020 and May 2021. MAIN MEASURES Percent of note text derived from each of five documentation tools: SmartTools, copy/paste, manual text, NoteWriter, and voice recognition and transcription; average total and after-hours EHR time per visit; average time on notes per visit. KEY RESULTS Six distinct note composition strategies emerged in cluster analyses. The most common strategy was predominant SmartTools use (n=89,718). In adjusted analyses, physicians using primarily transcription and dictation (n=15,928) spent less time on notes than physicians with predominant Smart Tool use. (b=-1.30, 95% CI=-1.62, -0.99, p<0.001; average 4.8 min per visit), while those using mostly copy/paste (n=23,426) spent more time on notes (b=2.38, 95% CI=1.92, 2.84, p<0.001; average 13.1 min per visit). CONCLUSIONS Physicians' note composition strategies have implications for both time in notes and after-hours EHR use, suggesting that how physicians use EHR-based documentation tools can be a key lever for institutions investing in EHR tools and training to reduce documentation time and alleviate EHR-associated burden.
Collapse
Affiliation(s)
- Lisa S Rotenstein
- Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA.
- Harvard Medical School, Boston, MA, USA.
| | - Nate Apathy
- Leonard Davis Institute of Health Economics, Wharton School, Philadelphia, PA, USA
- Department of Medicine, Perelman School of Medicine, Philadelphia, PA, USA
- Regenstrief Institute, Indianapolis, IN, USA
| | - A Jay Holmgren
- University of California at San Francisco, San Francisco, CA, USA
| | - David W Bates
- Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
- Department of Health Policy and Management, Harvard School of Public Health, Boston, MA, USA
| |
Collapse
|
26
|
Belfi LM, Chetlen A, Frigini A, Jay A, Methratta ST, Robbins J, Woods R, Deitte L. Recovering Joy in the Workplace Requires P.R.A.C.T.I.C.E. Acad Radiol 2023; 30:536-540. [PMID: 35654656 PMCID: PMC9151245 DOI: 10.1016/j.acra.2022.05.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 05/03/2022] [Accepted: 05/04/2022] [Indexed: 01/25/2023]
Affiliation(s)
- Lily M. Belfi
- Department of Radiology, Weill Cornell Medicine, 525 East 68th Street, Room F-054, New York, NY,Address correspondence to: L.M.B
| | - Alison Chetlen
- Department of Radiology, Penn State University, Hershey, Pennsylvania
| | | | - Ann Jay
- Department of Radiology, MedStar Georgetown University Hospital, Washington DC
| | | | - Jessica Robbins
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Ryan Woods
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Lori Deitte
- Department of Radiology, Vanderbilt University Medical Center, Nashville, Tennessee
| |
Collapse
|
27
|
McBride S, Alexander GL, Baernholdt M, Vugrin M, Epstein B. Scoping review: Positive and negative impact of technology on clinicians. Nurs Outlook 2023; 71:101918. [PMID: 36801609 DOI: 10.1016/j.outlook.2023.101918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Revised: 12/20/2022] [Accepted: 01/21/2023] [Indexed: 02/18/2023]
Abstract
BACKGROUND Unnecessary electronic health record (EHRs) documentation burden and usability issues have negatively impacted clinician well-being (e.g., burnout and moral distress). PURPOSE This scoping review was conducted by members from three expert panels of the American Academy of Nurses to generate consensus on the evidence of both positive and negative impact of EHRs on clinicians. METHODS The scoping review was conducted based on Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) Extension for Scoping Reviews guidelines. RESULTS The scoping review captured 1,886 publications screened against title and abstract 1,431 excluded, examined 448 in a full-text review, excluded 347 with 101 studies informing the final review. DISCUSSION Findings suggest few studies that have explored the positive impact of EHRs and more studies that have explored the clinician's satisfaction and work burden. Significant gaps were identified in associating distress to use of EHRs and minimal studies on EHRs' impact on nurses. CONCLUSION Examined the evidence of HIT's positive and negative impacts on clinician's practice, clinicians work environment, and if psychological impact differed among clinicians.
Collapse
Affiliation(s)
- Susan McBride
- School of Nursing, The University of Texas at Tyler, Tyler, TX.
| | | | | | | | - Beth Epstein
- University of Virginia School of Nursing, Charlottesville, VA
| |
Collapse
|
28
|
Mendelson A, Bandfield B, Hevezi J, Gable J, Davidson JE, Buckholz G. Using Photographs to Bring Dignity to Patients and Help Clinicians Find Meaning and Joy in Work. J Palliat Med 2023; 26:165-174. [PMID: 35997617 PMCID: PMC9894591 DOI: 10.1089/jpm.2022.0161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Background: The importance of dignity in health care is well described, yet limited interventions exist to improve dignity, particularly patient-driven interventions. Objectives: To test the hypothesis that patient-selected photographs at the bedside would impact patients' sense of dignity and clinicians' sense of meaningful work, stimulate conversation between patients and clinicians, and serve as a visual and patient-driven complement to the Patient Dignity Question (PDQ). Methods: Patients admitted to three units at an academic medical center displayed photographs above their head of bed and were interviewed for this study. We used thematic content analysis to compare themes extracted from patient interviews, the PDQ, and clinician surveys. Results: Eight themes emerged from patient interviews (n = 19): conveying goals, joy, capturing the patient's spirit, faith and spirituality, sense of belonging, physical appearance and health, stimulating conversation and meaningful connections, and humanizing the patient. The same themes emerged from the PDQ, with the exception of physical appearance and health. Notably, analysis of the clinician surveys (n = 40) yielded six similar themes: conveying goals, joy, stimulating conversation and meaningful connections, humanizing the patient, meaningful work, and compassion and empathy. Conclusions: Patient-selected photographs at the bedside impact both patients and clinicians by stimulating conversation and meaningful connections, humanizing patients, and fostering meaning and joy in work. Photographs and the PDQ provide a similar window into personhood, thereby supporting the use of a photograph as a visual and patient-driven complement to the PDQ.
Collapse
Affiliation(s)
- Ali Mendelson
- Kaiser Permanente Washington, Seattle, Washington, USA.,Address correspondence to: Ali Mendelson, MD, Kaiser Permanente Washington, Capital Hill Main Building, C140, 201 16th Avenue E, Seattle, WA 98122, USA
| | | | | | - Jason Gable
- UC San Diego Health, San Diego, California, USA
| | | | | |
Collapse
|
29
|
Alobayli F, O’Connor S, Holloway A, Cresswell K. Electronic Health Record Stress and Burnout Among Clinicians in Hospital Settings: A Systematic Review. Digit Health 2023; 9:20552076231220241. [PMID: 38130797 PMCID: PMC10734365 DOI: 10.1177/20552076231220241] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Accepted: 11/23/2023] [Indexed: 12/23/2023] Open
Abstract
Background There is growing evidence to suggest that EHRs may be associated with clinician stress and burnout, which could hamper their effective use and introduce risks to patient safety. Objective This systematic review aimed to examine the association between EHR use and clinicians' stress and burnout in hospital settings, and to identify the contributing factors influencing this relationship. Methods The search included peer-reviewed published studies between 2000 and 2023 in English in CINAHL, Ovid Medline, Embase, and PsychINFO. Studies that provided specific data regarding clinicians' stress and/or burnout related to EHRs in hospitals were included. A quality assessment of included studies was conducted. Results Twenty-nine studies were included (25 cross-sectional surveys, one qualitative study, and three mixed methods), which focused on physicians (n = 18), nurses (n = 10) and mixed professions (n = 3). Usability issues and the amount of time spent on the EHR were the most significant predictors, but intensity of the working environment influenced high EHR-related workload and thereby also contributed to stress and burnout. The differences in clinicians' specialties influenced the levels of stress and burnout related to EHRs. Conclusions This systematic review showed that EHR use was a perceived contributor to clinicians' stress and burnout in hospitals, primarily driven by poor usability and excessive time spent on EHRs. Addressing these issues requires tailored EHR systems, rigorous usability testing, support for the needs of different specialities, qualitative research on EHR stressors, and expanded research in Non-Western contexts.
Collapse
Affiliation(s)
- Fatimah Alobayli
- Nursing Studies, School of Health in Social Science, The University of Edinburgh, Edinburgh, UK
| | - Siobhan O’Connor
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, The University of Manchester, Manchester, UK
| | - Aisha Holloway
- Nursing Studies, School of Health in Social Science, The University of Edinburgh, Edinburgh, UK
| | - Kathrin Cresswell
- College of Medicine and Veterinary Medicine, Usher Institute, The University of Edinburgh, Edinburgh, UK
| |
Collapse
|
30
|
Rodríguez-Fernández JM, Loeb JA, Hier DB. It's time to change our documentation philosophy: writing better neurology notes without the burnout. Front Digit Health 2022; 4:1063141. [PMID: 36518562 PMCID: PMC9742203 DOI: 10.3389/fdgth.2022.1063141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 11/10/2022] [Indexed: 08/23/2023] Open
Abstract
Succinct clinical documentation is vital to effective twenty-first-century healthcare. Recent changes in outpatient and inpatient evaluation and management (E/M) guidelines have allowed neurology practices to make changes that reduce the documentation burden and enhance clinical note usability. Despite favorable changes in E/M guidelines, some neurology practices have not moved quickly to change their documentation philosophy. We argue in favor of changes in the design, structure, and implementation of clinical notes that make them shorter yet still information-rich. A move from physician-centric to team documentation can reduce work for physicians. Changing the documentation philosophy from "bigger is better" to "short but sweet" can reduce the documentation burden, streamline the writing and reading of clinical notes, and enhance their utility for medical decision-making, patient education, medical education, and clinical research. We believe that these changes can favorably affect physician well-being without adversely affecting reimbursement.
Collapse
Affiliation(s)
| | - Jeffrey A. Loeb
- Department of Neurology and Rehabilitation, University of Illinois at Chicago, Chicago, IL, United States
| | - Daniel B. Hier
- Department of Neurology and Rehabilitation, University of Illinois at Chicago, Chicago, IL, United States
- Department of Electrical and Computer Engineering, Missouri University of Science and Technology, Rolla, MO, United States
| |
Collapse
|
31
|
Rotenstein LS, Holmgren AJ, Healey MJ, Horn DM, Ting DY, Lipsitz S, Salmasian H, Gitomer R, Bates DW. Association Between Electronic Health Record Time and Quality of Care Metrics in Primary Care. JAMA Netw Open 2022; 5:e2237086. [PMID: 36255725 PMCID: PMC9579903 DOI: 10.1001/jamanetworkopen.2022.37086] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
IMPORTANCE Physicians across the US spend substantial time working in the electronic health record (EHR), with primary care physicians (PCPs) spending the most time. The association between EHR time and ambulatory care quality outcomes is unclear. OBJECTIVE To characterize measures of EHR use and ambulatory care quality performance among PCPs. DESIGN, SETTING, AND PARTICIPANTS A cross-sectional study of PCPs with longitudinal patient panels using a single EHR vendor was conducted at Brigham and Women's Hospital and Massachusetts General Hospital during calendar year 2021. EXPOSURES Independent variables included PCPs demographic and practice characteristics and EHR time measures (PCP-level mean of daily total EHR time, after-hours time, time from 5:30 pm to 7:00 am and time on weekends, and daily EHR time on notes, sending and receiving patient, staff, results, prescription, or system messages [in-basket], and clinical review). MAIN OUTCOMES AND MEASURES Outcome variables were ambulatory quality measures (year-end, PCP panel-level achievement of targets for hemoglobin A1c level control, lipid management, hypertension control, diabetes screening, and breast cancer screening). RESULTS The sample included 291 physicians (174 [59.8%] women). Median panel size was 829 (IQR, 476-1157) patients and mean (SD) clinical full-time equivalent was 0.54 (0.27). The PCPs spent a mean (SD) of 145.9 (64.6) daily minutes on the EHR. There were significant associations between EHR time and panel-level achievement of hemoglobin A1c control, hypertension control, and breast cancer screening targets. In adjusted analyses, each additional 15 minutes of total daily EHR time was associated with 0.58 (95% CI, 0.32-0.84) percentage point greater panel-level hemoglobin A1c control, 0.52 (95% CI, 0.33-0.71) percentage point greater hypertension control, and 0.28 (95% CI, 0.05-0.52) higher breast cancer screening rates. Each daily additional 15 minutes of in-basket time was associated with 2.26 (95% CI, 1.05-3.48) greater panel-wide hemoglobin A1c control, 1.65 (95% CI, 0.83-2.47) percentage point greater hypertension control, and 1.26 (95% CI, 0.51-2.02) percentage point higher breast cancer screening rates. Associations were largely concentrated among PCPs with 0.5 clinical full-time equivalent or less. There were no associations between EHR use metrics and diabetes screening or lipid management in patients with cardiovascular disease. CONCLUSIONS AND RELEVANCE This cross-sectional study found an association between EHR time and some measures of ambulatory care quality. Although increased EHR time is associated with burnout, it may represent a level of thoroughness or communication that enhances certain outcomes. It may be useful for future studies to characterize payment models, workflows, and technologies that enable high-quality ambulatory care delivery while minimizing EHR burden.
Collapse
Affiliation(s)
- Lisa S Rotenstein
- Division of General Internal Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - A Jay Holmgren
- Division of Hospital Medicine, Department of Medicine, University of California at San Francisco
| | - Michael J Healey
- Division of General Internal Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - Daniel M Horn
- Harvard Medical School, Boston, Massachusetts
- Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Boston
| | - David Y Ting
- Harvard Medical School, Boston, Massachusetts
- Department of Pediatrics, Massachusetts General Hospital, Boston
| | - Stuart Lipsitz
- Division of General Internal Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Hojjat Salmasian
- Division of General Internal Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - Richard Gitomer
- Division of General Internal Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - David W Bates
- Division of General Internal Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
- Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts
| |
Collapse
|
32
|
Li C, Parpia C, Sriharan A, Keefe DT. Electronic medical record-related burnout in healthcare providers: a scoping review of outcomes and interventions. BMJ Open 2022; 12:e060865. [PMID: 35985785 PMCID: PMC9396159 DOI: 10.1136/bmjopen-2022-060865] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE Healthcare provider (HCP) burnout is on the rise with electronic medical record (EMR) use being cited as a factor, particularly with the rise of the COVID-19 pandemic. Burnout in HCPs is associated with negative patient outcomes, and, therefore, it is crucial to understand and address each factor that affects HCP burnout. This study aims to (a) assess the relationship between EMR use and burnout and (b) explore interventions to reduce EMR-related burnout. METHODS We searched MEDLINE (Ovid), CINAHL and SCOPUS on 29 July 2021. We selected all studies in English from any publication year and country that discussed burnout in HCPs (physicians, nurse practitioners and registered nurses) related to EMR use. Studies must have reported a quantitative relationship to be included. Studies that implemented an intervention to address this burnout were also included. All titles and abstracts were screened by two reviewers, and all full-text articles were reviewed by two reviewers. Any conflicts were addressed with a third reviewer and resolved through discussion. Quality of evidence of all included articles was assessed using the Quality Rating Scheme for Studies and Other Evidence. FINDINGS The search identified 563 citations with 416 citations remaining after duplicate removal. A review of abstracts led to 59 studies available for full-text assessment, resulting in 25 studies included in the scoping review. Commonly identified associations between EMR-related burnout in HCPs included: message and alert load, time spent on EMRs, organisational support, EMR functionality and usability and general use of EMRs. Two articles employed team-based interventions to improve burnout symptoms without significant improvement in burnout scores. CONCLUSIONS AND RELEVANCE Current literature supports an association between EMR use and provider burnout. Very limited evidence exists for burnout-reducing interventions that address factors such as time spent on EMRs, organisational support or EMR design.
Collapse
Affiliation(s)
- Calandra Li
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Camilla Parpia
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Abi Sriharan
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Krembil Centre for Healthcare Management and Leadership, Schulich School of Business, Toronto, ON, Canada
| | - Daniel T Keefe
- University of Toronto, Toronto, Ontario, Canada
- Dalhousie University, Halifax, Nova Scotia, Canada
| |
Collapse
|
33
|
Rotenstein LS, Apathy N, Landon B, Bates DW. Assessment of Satisfaction With the Electronic Health Record Among Physicians in Physician-Owned vs Non-Physician-Owned Practices. JAMA Netw Open 2022; 5:e228301. [PMID: 35446397 PMCID: PMC9024386 DOI: 10.1001/jamanetworkopen.2022.8301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE Despite known benefits, electronic health records (EHRs) have had drawbacks for daily practice and the physician experience. There is evidence that physicians practicing in solo or physician-owned practices are more likely to be satisfied with the EHR and experience lower burnout than those practicing in other ownership arrangements; however, it is unclear how practice ownership patterns interact with physicians' experiences with the EHR and documentation in the EHR now that use of these systems is widespread. OBJECTIVE To examine the association between practice ownership and physician perceptions of the EHR. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study included non-federally employed physicians who provided office-based patient care in 2019 and completed the 2019 National Electronic Health Records Survey. The 2019 survey sample consisted of 1524 eligible responses (41.0% unweighted response rate representing 301 603 physicians); of those, 1368 physicians who reported having an EHR and answered questions regarding location ownership were included in the analysis. Data for the 2019 National Electronic Health Records Survey were collected by RTI International from June 14 to December 11, 2019; the current cross-sectional analysis was conducted from October 1 to November 30, 2021. MAIN OUTCOMES AND MEASURES Satisfaction with the EHR, perceptions of time spent on clinical documentation, and presence of staff support for documentation. RESULTS Among 1368 respondents (weighted, 270 813 respondents) included in the analysis, 960 respondents (weighted: 185,385 respondents [68.5%]) were male, and 951 respondents (weighted: 200,622 respondents [74.1%]) were over 50 years of age; 766 respondents (weighted, 161 226 respondents [59.5%]) were working in a practice owned by a physician or physician group, and 700 respondents (weighted, 131 284 respondents [48.5%]) were primary care physicians. A total of 602 respondents (weighted, 109 587 physicians [40.5%]) were working in a non-physician-owned practice. Overall, 529 respondents (weighted, 108 093 respondents [68.1%]) working in physician-owned practices reported being satisfied with their EHR vs 320 respondents (weighted, 63 988 respondents [58.5%]) working in non-physician-owned practices (P = .03). Among those working in physician-owned practices, perceptions that time spent on documentation was appropriate (328 physicians [weighted, 71 827 physicians (44.8%)] vs 191 physicians [weighted, 35 447 physicians (32.4%)]; P = .005) and that staff support for documentation was available (289 physicians [weighted, 57 702 physicians (36.0%)] vs 146 physicians [weighted, 29 267 physicians (26.7%)]; P = .02) were significantly higher compared with those working in non-physician-owned practices. Physicians' perceptions of the appropriateness of time spent and the availability of staff support only partially explained the association between practice ownership type and EHR satisfaction. CONCLUSIONS AND RELEVANCE The results of this nationally representative cross-sectional study suggest that physicians working in physician-owned practices are more likely to be satisfied with the EHR, to have positive perceptions of time spent on documentation, and to have staff support for documentation compared with their counterparts working in non-physician-owned practices. The workflow and cultural forces underlying these differences are important to understand in the setting of known differences in burnout by practice ownership type and ongoing physician group consolidation and acquisition by health care systems.
Collapse
Affiliation(s)
- Lisa S. Rotenstein
- Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
- Department of Medicine, Harvard Medical School, Boston, Massachusetts
| | - Nate Apathy
- Leonard Davis Institute of Health Economics, Wharton School, Philadelphia, Pennsylvania
- Department of Medicine, Perelman School of Medicine, Philadelphia, Pennsylvania
- Regenstrief Institute, Indianapolis, Indiana
| | - Bruce Landon
- Department of Medicine, Harvard Medical School, Boston, Massachusetts
- Department of Healthcare Policy, Harvard Medical School, Boston, Massachusetts
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - David W. Bates
- Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
- Department of Medicine, Harvard Medical School, Boston, Massachusetts
- Department of Health Policy and Management, Harvard School of Public Health, Boston, Massachusetts
| |
Collapse
|
34
|
Baron RJ. Why Might Physician-Owned Practices Be Happier With Their Electronic Health System Than Non-Physician-Owned Practices? JAMA Netw Open 2022; 5:e228309. [PMID: 35446399 DOI: 10.1001/jamanetworkopen.2022.8309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Richard J Baron
- American Board of Internal Medicine, Philadelphia, Pennsylvania
- ABIM Foundation, Philadelphia, Pennsylvania
| |
Collapse
|
35
|
Peccoralo LA, Pietrzak RH, Feingold JH, Syed S, Chan CC, Murrough JW, Kaplan C, Verity J, Feder A, Charney DS, Southwick SM, Ripp JA. A prospective cohort study of the psychological consequences of the COVID-19 pandemic on frontline healthcare workers in New York City. Int Arch Occup Environ Health 2022; 95:1279-1291. [PMID: 35064838 PMCID: PMC8783588 DOI: 10.1007/s00420-022-01832-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 01/06/2022] [Indexed: 12/20/2022]
Abstract
Objectives We sought to describe the course and correlates of psychological distress in frontline healthcare workers (FHCWs) during the COVID-19 pandemic in New York City (NYC). Methods A prospective cohort study of FHCWs at the Mount Sinai Hospital was conducted during the initial 2020 surge (T1) and 7 months later (T2). Psychological distress [i.e., positive screen for pandemic-related post-traumatic stress disorder (PTSD), major depressive disorder (MDD), and/or generalized anxiety disorder (GAD)], occupational and personal exposures to COVID-19, coping strategies, and psychosocial characteristics were assessed. Four courses of psychological distress response were identified: no/minimal, remitted, persistent, and new-onset. Multinomial logistic regression and relative importance analyses were conducted to identify factors associated with courses of distress. Results Of 786 FHCWs, 126 (16.0%) FHCWs had persistent distress; 150 (19.1%) remitted distress; 35 (4.5%) new-onset distress; and 475 (60.4%) no/minimal distress. Relative to FHCWs with no/minimal distress, those with persistent distress reported greater relationship worries [19.8% relative variance explained (RVE)], pre-pandemic burnout (18.7% RVE), lower dispositional optimism (9.8% RVE), less emotional support (8.6% RVE), and feeling less valued by hospital leadership (8.4% RVE). Relative to FHCWs with remitted symptoms, those with persistent distress reported less emotional support (29.7% RVE), fewer years in practice (28.3% RVE), and psychiatric history (23.6% RVE). Conclusions One-fifth of FHCWs in our study experienced psychological distress 7 months following the COVID-19 surge in NYC. Pandemic-related worries, pre-pandemic burnout, emotional support, and feeling valued by leaders were linked to persistent distress. Implications for prevention, treatment, and organizational efforts to mitigate distress in FHCWs are discussed. Supplementary Information The online version contains supplementary material available at 10.1007/s00420-022-01832-0.
Collapse
Affiliation(s)
- Lauren A Peccoralo
- Department of Medicine, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1087, New York, NY, 10029, USA.
- Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
| | - Robert H Pietrzak
- U.S. Department of Veterans Affairs National Center for Posttraumatic Stress Disorder, VA Connecticut Healthcare System, West Haven, CT, USA
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT, USA
| | - Jordyn H Feingold
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Shumayl Syed
- Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Chi C Chan
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Mental Illness Research, Education, and Clinical Center, James J. Peters VA Medical Center, Bronx, NY, USA
| | - James W Murrough
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Depression and Anxiety Center for Discovery and Treatment, New York, USA
- Department of Neuroscience, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Carly Kaplan
- Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Jaclyn Verity
- Department of Medicine, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1087, New York, NY, 10029, USA
| | - Adriana Feder
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Dennis S Charney
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Neuroscience, Icahn School of Medicine at Mount Sinai, New York, USA
| | | | - Jonathan A Ripp
- Department of Medicine, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1087, New York, NY, 10029, USA
- Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| |
Collapse
|
36
|
Abstract
Burnout is a response to sustained job stressors manifesting as a classic triad of emotional exhaustion, depersonalization, and a sense of reduced accomplishment. With 42% of physicians demonstrating some symptoms of burnout, this has already reached epidemic proportions. The COVID-19 pandemic has only worsened this phenomenon.
Collapse
Affiliation(s)
- Aarti Chandawarkar
- Division of Clinical Informatics, Nationwide Children's Hospital, Columbus, OH, United States; Section of Primary Care Pediatrics Nationwide Children's Hospital, Columbus, OH, United States; Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, United States; Department of Biomedical Informatics, The Ohio State University College of Medicine, Columbus, OH, United States.
| | - Juan D Chaparro
- Division of Clinical Informatics, Nationwide Children's Hospital, Columbus, OH, United States; Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, United States; Department of Biomedical Informatics, The Ohio State University College of Medicine, Columbus, OH, United States
| |
Collapse
|
37
|
Almulhem JA, Aldekhyyel RN, Binkheder S, Temsah MH, Jamal A. Stress and Burnout Related to Electronic Health Record Use among Healthcare Providers during the COVID-19 Pandemic in Saudi Arabia: A Preliminary National Randomized Survey. Healthcare (Basel) 2021; 9:1367. [PMID: 34683047 PMCID: PMC8544434 DOI: 10.3390/healthcare9101367] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Revised: 10/09/2021] [Accepted: 10/11/2021] [Indexed: 02/03/2023] Open
Abstract
Healthcare providers' burnout may potentially have a negative impact on patient care. The use of the electronic health record (EHR) increases the burden for healthcare providers (HCPs), particularly during the coronavirus disease-2019 (COVID-19) pandemic. This study assessed the stress and burnout related to the use of EHRs and health information technology (HIT) tools among HCPs during COVID-19 in Saudi Arabia. We used a self-developed survey tool. It consisted of five sections; demographics and professional data, experience using EHR, effects of EHR use, use of EHR and technology tools during COVID-19, and health and wellbeing. The survey link was emailed to a random sample of HCPs registered with a national scientific regulatory body. Univariate, bivariate, and multivariate analyses were performed to measure the association between burnout and study variables. A total of 182 participants completed the survey. 50.5% of participants reported a presence of HIT-related stress, and 40.1% reported a presence of burnout. The variables independently associated with burnout were providing tertiary level of care, working with COVID-19 suspected cases, dissatisfaction with EHRs, and agreement with the statement that using EHRs added frustration to the workday. Further research that explores possible solutions is warranted to minimize burnout among HCPs, especially during infectious outbreaks.
Collapse
Affiliation(s)
- Jwaher A. Almulhem
- Medical Informatics and E-learning Unit, Medical Education Department, College of Medicine, King Saud University, Riyadh 11362, Saudi Arabia; (R.N.A.); (S.B.)
| | - Raniah N. Aldekhyyel
- Medical Informatics and E-learning Unit, Medical Education Department, College of Medicine, King Saud University, Riyadh 11362, Saudi Arabia; (R.N.A.); (S.B.)
| | - Samar Binkheder
- Medical Informatics and E-learning Unit, Medical Education Department, College of Medicine, King Saud University, Riyadh 11362, Saudi Arabia; (R.N.A.); (S.B.)
| | - Mohamad-Hani Temsah
- Pediatric Department, College of Medicine, King Saud University, Riyadh 11362, Saudi Arabia;
| | - Amr Jamal
- Evidence-Based Health Care & Knowledge Translation Research Chair, King Saud University, Riyadh 11362, Saudi Arabia;
- Family & Community Medicine Department, College of Medicine, King Saud University, Riyadh 11362, Saudi Arabia
| |
Collapse
|
38
|
Mosquera MJ, Ward HB, Holland C, Boland R, Torous J. Using objective clinical metrics to understand the relationship between the electronic health record and physician well-being: observational pilot study. BJPsych Open 2021; 7:e174. [PMID: 34545781 PMCID: PMC8485348 DOI: 10.1192/bjo.2021.993] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Electronic health records (EHRs) are a significant contributor to physicians' low satisfaction, reduced engagement and increased burnout. Yet the majority of evidence around EHR and physician harms is based on self-reported screen time, which may both over- and underreport actual exposure. AIMS The purpose of this study was to examine how objective EHR use correlates with physician well-being and to develop preliminary recommendations for well-being-based EHR interventions. METHOD Prior to the onset of COVID-19, psychiatry residents and attending physicians working in an out-patient clinic at an academic medical centre provided consent for access to EHR-usage logs and completed a well-being assessment made up of three scales: the Maslach Burnout Inventory, the Urecht Work Engagement Scale and the Professional Quality of Life Measure. Survey responses and objective EHR data were analysed with descriptive statistics. RESULTS Responses were obtained from 20 psychiatry residents (total eligible residents n = 27; 74% participation) and 16 clinical faculty members (total eligible faculty n = 24; 67% participation) with an overall response rate of 71% (total eligible residents and faculty n = 51 and total residents and faculty who completed survey n = 36). Moderate correlations for multiple well-being domains emerged in analysis for all participants, especially around the time spent per note and patient visits closed the same day. CONCLUSIONS EHR-usage logs represent an objective tool in the evaluation and enhancement of physician well-being. Results from our pilot study suggest that metrics for note writing efficiency and closing patient visits the same day are associated with physician well-being. These metrics will be important to study in ongoing efforts involving well-being-based EHR interventions.
Collapse
Affiliation(s)
- Matthew J Mosquera
- Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, USA
| | - Heather Burrell Ward
- Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, USA
| | | | - Robert Boland
- Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, USA
| | - John Torous
- Digital Psychiatry Division, Beth Israel Deaconess Medical Center, Harvard Medical School, USA
| |
Collapse
|
39
|
Poon EG, Trent Rosenbloom S, Zheng K. Health information technology and clinician burnout: Current understanding, emerging solutions, and future directions. J Am Med Inform Assoc 2021; 28:895-898. [PMID: 33871016 DOI: 10.1093/jamia/ocab058] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 03/11/2021] [Indexed: 02/01/2023] Open
Affiliation(s)
- Eric G Poon
- Duke Health Technology Solutions, Duke University Health System, Durham, North Carolina, USA.,Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
| | - S Trent Rosenbloom
- Department of Biomedical Informatics, Vanderbilt University School of Medicine, Nashville, Tennessee, USA.,Department of Pediatrics & Department of Internal Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Kai Zheng
- Department of Informatics, University of California, Irvine, Irvine, California, USA
| |
Collapse
|