EHRs can offer benefits along with burnout
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KANSAS CITY, Missouri — Electronic health records have a utilitarian benefit for practice managers but may also worsen the interaction between patients and their caregivers, a presenter said at the Annual Dialysis Conference.
“Electronic health records represent a certain trade off that we have to become comfortable with,” Robert P. Pauly, MD, from the University of Alberta, said in a keynote presentation.
EHRs can reduce costs, increase revenue, improve storage management, aid in providing disease management, and assist in patient empowerment, learning and decision making. However, EHRs also increase physician workload, can negatively impact clinical interaction and can add to burnout, Pauly said.
He referenced a two-part study showing physicians spend 5.9 hours a day using EHRs, 4.5 of which were during the workday, and 1.4 after. Overall, this adds up to about 30 hours per month using EHRs. While others might consider this unpaid overtime, Pauly called time spent outside of work on EHRs “pajama time.”
A major reason that EHRs can consume so much of a physician’s time is poor inbox management. One study Pauly referenced showed clinicians spend up to 6 hours per month after work on inbox management. Consequently, this leads to more time using EHRs to develop correct answers for the inbox emails.
A common complaint about EHRs is its impact on patient interaction. Not only do EHRs require screen time, leading to time spent looking away from the patient, many clinician’s offices aren’t designed for computers. Old buildings turned into offices often have outlets and computer technology in the corner of the room, Pauly said, which means physicians have to be purposely creative if they are going to face both the screen and the patient at the same time.
“The introduction of the computer or the EHR into a patient-clinician interaction changes that interaction, and that change isn't always for the better,” Pauly said. “That has some important implications for the deliberateness with which we provide care, and importantly, how we educate the next generation of clinicians.”
In addition to time consumption and limited patient interaction, EHRs can create information chaos, he said. This is due to a lack of standardized rules, meaningful agreement of curated information and how the systems were never designed for integrated clinical care in the first place. In fact, Pauly said, EHRs were created mainly for billing and insurance purposes.
In a study that compared information overload created by EHRs vs. paper records, researchers found that EHRs offload tasks to physicians that were once done by supporting teams. While EHR usage correlates with burnout, Pauly noted that no one can know if burnout would have occurred without technology, or if it truly can be attributed to the functionality of EHRs.
Because EHRs can be beneficial and does have many positive aspects to it, Pauly found the functionality to be the root of many physician’s frustrations. Compared to a google search with a system usability scale (SUS) score of 93, a study from the American Medical Association found the adapted mean score of EHR is 46. For every one-point increase in SUS score, there is 3% lower odds of burnout. Therefore, physicians using EHRs have a high likelihood of experiencing burnout.
“So, the things that are in our control are how we as clinical groups deal with this, and how we as individuals do so as well,” Pauly concluded.
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Pauly R. The electronic health record: The thing we love to hate and what it means for clinician well-being. Presented at: Annual Dialysis Conference. March 3-6, 2023; Kansas City, Missouri.
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