More Electronic Health Record Messages Linked to Physician Burnout

Ming Tai-Seale, PhD, MPH

According to a new observational study, a large volume of system generated electronic health record (EHR) messages is tied to a higher probability of physician burnout, suggesting that a redesign of the EHR system could increase physicians’ well-being.

A research team, led by Ming Tai-Seale, PhD, MPH, from the University of California San Diego has found 36% of the physicians in the study self-reported symptoms of being burnt out from a confidential survey of primary and specialty care physicians from the Palo Alto Medication Foundation, with 29% indicating that they will cut back on clinical work in the next calendar year.

They also found that a greater-than-average number of messages received was linked to a 40% higher probability of being burnt out, and a 38% higher probability in the intention of reducing clinical time.

The researchers used a combination of a confidential one-page survey of 934 primary and specialty care physicians, as well as administrative and EHR data, from a six-week period in 2016, including those from patients and other clinicians, as well as messages generated by the EHR system. The investigators also measured the time it took to enter progress notes into the EHR system.

They grouped the specialties into 6 categories—family medicine, internal medicine, pediatrics, surgical, non-surgical procedural, and management-oriented services.

The researchers discovered the in-basket messages generated from the EHR system accounted for 114 of the 243 (46.9%) weekly messages received per physician, with 30 messages coming from patients, 53 from other physicians or care team members and 31 from the physicians themselves.

Ultimately, 45% of physicians with burnout symptoms received more than the average number of system-generated in-basket messages, while just 29% of the physicians with these symptoms receiving average or less than average amounts of messages.

The team also analyzed the relationship between life satisfaction and explanatory variables and found that the average score on life satisfaction was 78.22 out of a possible 100.

The physicians who perceived their work environment positively also were less likely to report symptoms of burning out or the intention of reducing clinical work time.

The investigators also sought out gender disparity in physician burnout; they found female doctors were at a greater risk.

As a result of the study, investigators suggest that a better understanding of the relationship between doctor well-being and desktop medicine work in the EHR as well as the work environment could help more effectively address burnout. They noted that 1 of the issues that the EHR system creates is a challenging 24-hour work environment for physicians.

In the past, physician burnout studies have primarily focused on workload, efficiency, purpose of work, culture and values, control and flexibility, social support and community at work, and work-life integration.

Tai-Seale and colleagues noted just 1 previous study examined the effect of EHR workload on burnout, relying on physicians’ self-reporting the time they use EHRs and computerized order entry. That study found burnout was only linked to the time spent on computerized order entry.

Research literature also showed the more a physician spends on the EHR, the less they are satisfied with work. Upon analyzing EHR log data for 471 primary care physicians, investigators found that about half of physician’s time is spent on desktop medicine tasks.

They also cited another family physician study showed that managing the EHR’s in-basket takes up about 23% of the workday.

“The EHR has become the symbol of physician burnout,” investigators wrote. “The reality of physician wellness is complex, however.”

The study, “Physicians’ Well-Being Linked To In-Basket Messages Generated By Algorithms In Electronic Health Records,” was published online in Health Affairs.