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Perceived Value of the Electronic Health Record and Its Association with Physician BurnoutFunding This project was supported in part by grant number R18HS022065 from the Agency for Healthcare Research and Quality (AHRQ), U.S. Department of Health and Human Services.
Background There is a common belief that seniority and gender are associated with clinicians' perceptions of the value of electronic health record (EHR) technology and the propensity for burnout. Insufficient evidence exists on the relationship between these variables.
Objective The aim of this study was to investigate how seniority/years of practice, gender, and screened burnout status are associated with opinions of EHR use on quality, cost, and efficiency of care.
Methods We surveyed ambulatory primary care and subspecialty clinicians at three different institutions to screen for burnout status and to measure their opinions (positive, none, negative, don't know) on how EHR technology has impacted three important attributes of health care: quality, cost, and efficiency of care. We used chi-square tests to analyze association between years of practice (≤10 years or 11+ years), gender, and screened burnout status and the reported attributes. We used a Bonferroni-corrected α = 0.0167 for significance to protect against type I error among multiple comparisons.
Results Overall, 281 clinicians responded from 640 that were surveyed with 44% overall response rate. There were no significant associations of years in practice (≤10 years or 11+ years) or gender (p > 0.0167 for both) with any of the health care attributes. Clinicians who screened burnout negative (n = 154, 55%) were more likely to indicate that EHR technology has a positive impact on both the quality (p = 0.0025) and efficiency (p = 0.0003) health care attributes compared with those who screened burnout positive (n = 127, 45%).
Conclusion Burnout status is significantly associated with clinicians' perceived value of EHR technologies, while years of practice and gender are not. This contests the popular notion that junior clinicians view EHR technology more favorably than their more senior counterparts. Hence, burnout status may be an important factor associated with the overall value clinicians ascribe to EHR technologies.
Keywordspeople - burnout - documentation burden - workflows and human interactions - human–computer interaction - interfaces and usability - culture - workarounds and unanticipated consequences - user acceptance and resistance
Protection of Human and Animal Subjects
This study was determined to be exempt research by the Western Michigan University Homer Stryker M.D. School of Medicine Institutional Review Board.
Received: 01 April 2022
Accepted: 01 July 2022
Article published online:
18 August 2022
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- 1 Shanafelt TD, West CP, Sinsky C. et al. Changes in burnout and satisfaction with work-life integration in physicians and the general us working population between 2011 and 2020. Mayo Clin Proc 2022; 97 (03) 491-506
- 2 Gardner RL, Cooper E, Haskell J. et al. Physician stress and burnout: the impact of health information technology. J Am Med Inform Assoc 2019; 26 (02) 106-114
- 3 Grow HM, McPhillips HA, Batra M. Understanding physician burnout. Curr Probl Pediatr Adolesc Health Care 2019; 49 (11) 100656-100610
- 4 Kroth PJ, Morioka-Douglas N, Veres S. et al. Association of electronic health record design and use factors with clinician stress and burnout. JAMA Netw Open 2019; 2 (08) e199609
- 5 Menachemi N, Collum TH. Benefits and drawbacks of electronic health record systems. Risk Manag Healthc Policy 2011; 4: 47-55
- 6 Adane K, Gizachew M, Kendie S. The role of medical data in efficient patient care delivery: a review. Risk Manag Healthc Policy 2019; 12: 67-73
- 7 Khairat S, Burke G, Archambault H, Schwartz T, Larson J, Ratwani RM. Perceived burden of ehrs on physicians at different stages of their career. Appl Clin Inform 2018; 9 (02) 336-347
- 8 Wu DTY, Xu C, Kim A, Bindhu S, Mah KE, Eckman MH. A scoping review of health information technology in clinician burnout. Appl Clin Inform 2021; 12 (03) 597-620
- 9 Sinha A, Shanafelt TD, Trockel M, Wang H, Sharp C. Novel nonproprietary measures of ambulatory electronic health record use associated with physician work exhaustion. Appl Clin Inform 2021; 12 (03) 637-646
- 10 Gregory ME, Russo E, Singh H. Electronic health record alert-related workload as a predictor of burnout in primary care providers. Appl Clin Inform 2017; 8 (03) 686-697
- 11 Gardner DRL, Cooper E, Haskell J. et al. Response to “Impact of HIT on burnout remains unknown - for now”. J Am Med Inform Assoc 2019; 26 (11) 1421
- 12 Robertson SL, Robinson MD, Reid A. Electronic health record effects on work-life balance and burnout within the i(3) population collaborative. J Grad Med Educ 2017; 9 (04) 479-484
- 13 Marmor RA, Clay B, Millen M, Savides TJ, Longhurst CA. The impact of physician EHR usage on patient satisfaction. Appl Clin Inform 2018; 9 (01) 11-14
- 14 Frintner MP, Kaelber DC, Kirkendall ES, Lourie EM, Somberg CA, Lehmann CU. The effect of electronic health record burden on pediatricians' work-life balance and career satisfaction. Appl Clin Inform 2021; 12 (03) 697-707
- 15 Chesak SS, Cutshall S, Anderson A, Pulos B, Moeschler S, Bhagra A. Burnout among women physicians: a call to action. Curr Cardiol Rep 2020; 22 (07) 45
- 16 McPeek-Hinz E, Boazak M, Sexton JB. et al. Clinician burnout associated with sex, clinician type, work culture, and use of electronic health records. JAMA Netw Open 2021; 4 (04) e215686
- 17 Rittenberg E, Liebman JB, Rexrode KM. Primary care physician gender and electronic health record workload. J Gen Intern Med 2022; DOI: 10.1007/s11606-021-07298-z.
- 18 Khairat S, Xi L, Liu S, Shrestha S, Austin C. Understanding the association between electronic health record satisfaction and the well-being of nurses: survey study. JMIR Nurs 2020; 3 (01) e13996
- 19 Nakagawa K, Yellowlees P. Inter-generational effects of technology: why millennial physicians may be less at risk for burnout than baby boomers. Curr Psychiatry Rep 2020; 22 (09) 45
- 20 Meyer J. Workforce age and technology adoption in small and medium-sized service firms. Small Bus Econ 2011; 37 (03) 305-324
- 21 Morris MG, Venkatesh V. Age differences in technology adoption decisions: implications for a changing work force. Person Psychol 2000; 53 (02) 375-403
- 22 de Koning J, Gelderblom A. ICT and older workers: no unwrinkled relationship. Int J Manpow 2006; 27: 467-490
- 23 Jamoom EW, Heisey-Grove D, Yang N, Scanlon P. Physician opinions about ehr use by ehr experience and by whether the practice had optimized its ehr use. J Health Med Inform 2016; 7 (04) 1000240
- 24 Kroth PJ, Morioka-Douglas N, Veres S. et al. MS-squared survey instrument v 2.0. 2019. Accessed March 4, 2022 at: https://digitalrepository.unm.edu/ms2/3/
- 25 Harris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG. Research electronic data capture (REDCap)–a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform 2009; 42 (02) 377-381
- 26 Harris PA, Taylor R, Minor BL. et al; REDCap Consortium. The REDCap consortium: building an international community of software platform partners. J Biomed Inform 2019; 95: 103208
- 27 Linzer M, Gerrity M, Douglas JA. et al. Physician stress: results from the physician worklife study. Stress Health 2002; 18 (01) 37-42
- 28 Rohland BM, Kruse GR, Rohrer JE. Validation of a single-item measure of burnout against the maslach burnout inventory among physicians. Stress Health 2004; 20: 75-79
- 29 Office of the National Coordinator for Health Information Technology. Office-based physician electronic health record adoption. Health IT Quick-Stat #50. 2021. Accessed March 4, 2022 at: https://www.healthit.gov/data/quickstats/office-based-physician-electronic-health-record-adoption
- 30 Seu M, Cho BH, Pigott R. et al. Trends and perceptions of electronic health record usage among plastic surgeons. Plast Reconstr Surg Glob Open 2020; 8 (04) e2709
- 31 Williams DC, Warren RW, Ebeling M, Andrews AL, Teufel Ii RJ. Physician use of electronic health records: survey study assessing factors associated with provider reported satisfaction and perceived patient impact. JMIR Med Inform 2019; 7 (02) e10949
- 32 Nguyen OT, Jenkins NJ, Khanna N. et al. A systematic review of contributing factors of and solutions to electronic health record-related impacts on physician well-being. J Am Med Inform Assoc 2021; 28 (05) 974-984
- 33 Emani S, Ting DY, Healey M. et al. Physician beliefs about the impact of meaningful use of the EHR: a cross-sectional study. Appl Clin Inform 2014; 5 (03) 789-801
- 34 Holmgren AJ, Lindeman B, Ford EW. Resident physician experience and duration of electronic health record use. Appl Clin Inform 2021; 12 (04) 721-728
- 35 Ganguli I, Sheridan B, Gray J, Chernew M, Rosenthal MB, Neprash H. Physician work hours and the gender pay gap - evidence from primary care. N Engl J Med 2020; 383 (14) 1349-1357
- 36 Khairat S, Coleman C, Ottmar P, Bice T, Koppel R, Carson SS. Physicians' gender and their use of electronic health records: findings from a mixed-methods usability study. J Am Med Inform Assoc 2019; 26 (12) 1505-1514
- 37 Lou SS, Liu H, Warner BC, Harford D, Lu C, Kannampallil T. Predicting physician burnout using clinical activity logs: model performance and lessons learned. J Biomed Inform 2022; 127: 104015
- 38 Yan Q, Jiang Z, Harbin Z, Tolbert PH, Davies MG. Exploring the relationship between electronic health records and provider burnout: a systematic review. J Am Med Inform Assoc 2021; 28 (05) 1009-1021
- 39 Harris DA, Haskell J, Cooper E, Crouse N, Gardner R. Estimating the association between burnout and electronic health record-related stress among advanced practice registered nurses. Appl Nurs Res 2018; 43: 36-41
- 40 Tajirian T, Stergiopoulos V, Strudwick G. et al. The influence of electronic health record use on physician burnout: cross-sectional survey. J Med Internet Res 2020; 22 (07) e19274
- 41 Melnick ER, Dyrbye LN, Sinsky CA. et al. The association between perceived electronic health record usability and professional burnout among us physicians. Mayo Clin Proc 2020; 95 (03) 476-487
- 42 Eschenroeder HC, Manzione LC, Adler-Milstein J. et al. Associations of physician burnout with organizational electronic health record support and after-hours charting. J Am Med Inform Assoc 2021; 28 (05) 960-966
- 43 English EF, Holmstrom H, Kwan BW. et al. Virtual sprint outpatient electronic health record training and optimization effect on provider burnout. Appl Clin Inform 2022; 13 (01) 10-18
- 44 Marckini DN, Samuel BP, Parker JL, Cook SC. Electronic health record associated stress: a survey study of adult congenital heart disease specialists. Congenit Heart Dis 2019; 14 (03) 356-361