Year of Publication

2020

College

Public Health

Degree Name

Master of Public Health (M.P.H.)

Committee Chair

Dr. Martha Riddell

Committee Member

Dr. Richard Ingram

Committee Member

Dr. Sarah Wackerbarth

Abstract

Background: After the passing of the Health Information Technology for Economic and Clinical Health (HITECH) Act in 2009, there has been a tremendous increase in the number of hospitals and providers adopting and using Electronic Health Records (EHRs). While EHRs were a way of improving efficiency, quality, and safety of healthcare, there is emerging evidence that they are contributing to physician burden, which can take the form of increased workload, decreased satisfaction, negative attitudes, and burnout. For instance, Arndt et al. found that physicians spent half of their workday on the EHR during and after work, and Robertson et al. found that time spent on the EHR after hours was associated with burnout and decreased work-life balance.

Purpose: This capstone project is a rapid review of the research on physician burden and EHR use in the U.S. between January 2015 to February 2020. Its purpose is to assess recurring themes within recent literature focused on EHR-related physician burden.

Methods: Articles were found on PubMed using MeSH terms. Physician burden was defined by four MeSH terms: “burnout, psychological”, “workload”, “job satisfaction”, and “attitude of health personnel.” Articles were assessed based on inclusion and exclusion criteria. Inclusion criteria were 1) research articles, 2) sample populations in the US, 3) English language, 4) articles focused on physician burden and EHR use. Exclusion criteria were non-research articles, study populations outside of the US, not in English, and not focused on physicians, physician burden, or EHR use. The PubMed search resulted in 174 results and 21 articles were found from other sources. The articles were assessed based on their abstracts then their full text. After assessment, 28 articles met inclusion criteria. The 28 articles were then grouped based on quantitative vs qualitative methods, data types, and specific major themes.

Results: Twenty-eight articles were included in the rapid review. Twenty-seven articles used quantitative methods and 1 article used qualitative methods. Of the 27 quantitative articles, 16 used surveys, 6 used log data, 2 used direct observation and 3 used a mix of quantitative methods. The one qualitative study used interviews. Major themes were burnout, workload, satisfaction, attitudes, and time tracking. The number of respondents with burnout ranged from 24.1% to over 60%. Six out of nine articles found burnout associated with not enough time on documentation, high total amount to EHR use, EHR use after work, low EHR usability, and higher number of in-box messages. For satisfaction, 4/8 studies found a negative association between satisfaction and EHR use, while the other 4 articles found either positive satisfaction with EHR use or no association between EHR use and overall job satisfaction. Workload increased with EHR use in the form of increased effort processing in-box messages, generating after visit summaries, increased administrative time, increased time on documentation and chart review. Negative attitudes included inaccurate information and decreased meaningful patient-provider interaction. Positive attitudes included faster lab results and better provider communication. Around half of clinic time is spent on the EHR and after work EHR use ranged from 21 minutes to 2.5 hours. Conclusion and Implications: Physician burden is a growing issue in the U.S. and EHR use is an unintended contributor to physician burden in the form of increased burnout and workload. Improving EHR use among physicians is an important part of reducing physician burden in the US, which can be done by using scribes, improving EHR training, improving EHR usability, and reducing documentation and billing requirements for providers.

Available for download on Tuesday, April 27, 2021

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