Electronic Health Record Alert-Related Workload as a Predictor of Burnout in Primary Care ProvidersFunding The research reported here was supported in part by the U.S. Department of Veterans Affairs, Veterans Health Administration, Health Services Research and Development Service, Office of Academic Affiliations, Health Professions Education Evaluation and Research Advanced Fellowship and in part by Center for Innovations in Quality, Effectiveness and Safety (CIN 13–413), Michael E. DeBakey VA Medical Center, Houston, TX.
Dr. Singh is additionally supported by the VA Health Services Research and Development Service (CRE 12–033; Presidential Early Career Award for Scientists and Engineers USA 14–274), the VA National Center for Patient Safety, and the Agency for Health Care Research and Quality (R01HS022087 and R21HS023602). The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the U.S. Department of Veterans Affairs or the United States government.
03 January 2017
accepted: 21 April 2017
20 December 2017 (online)
Background: Electronic health records (EHRs) have been shown to increase physician workload. One EHR feature that contributes to increased workload is asynchronous alerts (also known as inbox notifications) related to test results, referral responses, medication refill requests, and messages from physicians and other health care professionals. This alert-related workload results in negative cognitive outcomes, but its effect on affective outcomes, such as burnout, has been under-studied.
Objectives: To examine EHR alert-related workload (both objective and subjective) as a predictor of burnout in primary care providers (PCPs), in order to ultimately inform interventions aimed at reducing burnout due to alert workload.
Methods: A cross-sectional questionnaire and focus group of 16 PCPs at a large medical center in the southern United States.
Results: Subjective, but not objective, alert workload was related to two of the three dimensions of burnout, including physical fatigue (p = 0.02) and cognitive weariness (p = 0.04), when controlling for organizational tenure. To reduce alert workload and subsequent burnout, participants indicated a desire to have protected time for alert management, fewer unnecessary alerts, and improvements to the EHR system.
Conclusions: Burnout associated with alert workload may be in part due to subjective differences at an individual level, and not solely a function of the objective work environment. This suggests the need for both individual and organizational-level interventions to improve alert workload and subsequent burnout. Additional research should confirm these findings in larger, more representative samples.
Citation: 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: 686–697 https://doi.org/10.4338/ACI-2017-01-RA-0003
Clinical Relevance Statement
While the knowledge on various components of workload and methods regarding how to measure these components is well-grounded [–], there is a dearth of studies that examine the impact of both objective and subjective workload on work outcomes. To our knowledge, this is one of the first to show that subjective, but not objective, workload leads to negative affective outcomes (i.e., burnout). This finding is important in guiding future research and in informing improvements in EHR design and processes to manage inbox alerts.
Human Subjects Protections
This study was approved by the Baylor College of Medicine Institutional Review Board and the local VA Research Office.
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