Better Usability and Technical Stability Could Lead to Better Work-Related Well-Being among Physicians
09 June 2017
06 September 2017
14 December 2017 (online)
Background and Objective Finnish physicians have been increasingly dissatisfied with poor usability of the electronic patient record (EPR) systems, which they have identified as an overload factor in their work. Our aim is to specify which factors in EPRs are associated with work-related well-being of physicians.
Methods A web-based questionnaire was sent to Finnish physicians younger than 65 years; the responses (n = 3,781) represent one-fourth of these. This was a repetition of a survey in 2010, where this questionnaire was used for the first time. In addition to statements assessing usability, there were questions measuring time pressure and job control. The relation between usability and work well-being was investigated with hierarchical multivariate regression analyses: With time pressure and job control as dependent variables, EPR usability assessments and physicians' background information were used as independent variables.
Results In the multivariate analyses, technical problems that are often experienced in the EPR were related to higher time pressure and lower job control. Active participation in the development of the EPR system was related to stronger time pressure and stronger job control. In addition, use of several systems daily and the experience of time-consuming documentation of patient information for statistical purposes (billing, national registries, and reporting) were related to higher time pressure, while those with longer experience with the EPR system and those experiencing easy-to-read nursing records reported higher job control.
Conclusion To relieve time pressure and increase sense of job control experienced by physicians, usability, integrations, and stability of the EPR systems should be improved: fewer login procedures, easier readability of nursing records, and decreased need for separate documentation for statistical purposes. Physician participation in the EPR development would increase the feeling of job control, but would add the time pressure. Hence, time for developmental work should be arranged.
Keywordselectronic patient records and systems - patient records - specific software - clinical IT systems - usability - workflows
Protection of Human and Animal Subjects
According to Finnish legislation, no ethical assessment or approval is mandatory for a study such as this. The Finnish law (Medical Research Act 1999/488, 2004/295, 2010/794) states medical research requiring the approval of an appropriate ethics committee as follows: research involving intervention in the integrity of a person, human embryo, or human fetus for the purpose of increasing knowledge or the nature of diseases in general. Our study is a behavioral study and compiled information on the social background and work history, placing on the market and physicians' experiences on EPR usability and work well-being. These cannot be regarded as providing sensitive, potentially harmful information about the participants.
According to the local and national ethical instructions for research (Finnish Advisory Board on Research Integrity: http://www.tenk.fi/en/request-for-ethical-review-in-human-sciences) instructions, this study did not require ethical approval. The autonomy of research subjects was respected, there was informed consent, no harm was possible for the subjects and confidentiality of the subjects, and research data were protected.
The study has been funded by the Finnish Work Environment Fund (project no. 116104), Strategic Research Council (SRC) at the Academy of Finland (project nos. 303604 and 303605), and the Finnish Ministry of Social Affairs and Health (project no. 514916001).
- 1 Laur A. Fear of e-Health records implementation?. Med Leg J 2015; 83 (01) 34-39
- 2 Chen Y, Lorenzi N, Nyemba S, Schildcrout JS, Malin B. We work with them? Healthcare workers interpretation of organizational relations mined from electronic health records. Int J Med Inform 2014; 83 (07) 495-506
- 3 Poissant L, Pereira J, Tamblyn R, Kawasumi Y. The impact of electronic health records on time efficiency of physicians and nurses: a systematic review. J Am Med Inform Assoc 2005; 12 (05) 505-516
- 4 Vishwanath A, Singh SR, Winkelstein P. The impact of electronic medical record systems on outpatient workflows: a longitudinal evaluation of its workflow effects. Int J Med Inform 2010; 79 (11) 778-791
- 5 Friedberg MW, Chen PG, Van Busum KR. , et al. Factors affecting physician professional satisfaction and their implications for patient care, health systems, and health policy. Rand Health Q 2014; 3 (04) 1
- 6 Heponiemi T, Vänskä J, Aalto A, Elovainio M. Changes in stress factors and psychosocial resources among Finnish physicians between 2006 and 2010. Suom Laakaril 2012; 67 (47) 3491-3495
- 7 Vänskä J. Lääkärien työolot ja terveys 2015. 2016; Available at: https://www.laakariliitto.fi/site/assets/files/1266/l_k_rin_ty_olot_ja_terveys_2015_tuloksia.pdf . Accessed October 1, 2016
- 8 Kuusio H, Heponiemi T, Aalto AM, Sinervo T, Elovainio M. Differences in well-being between GPs, medical specialists, and private physicians: the role of psychosocial factors. Health Serv Res 2012; 47 (1, Pt 1): 68-85
- 9 Aalto AM, Elovainio M, Heponiemi T, Hietapakka L, Kuusio H, Lämsä R. Doctors and nurses of foreign origin in Finnish health care - challenges and possibilities. 2013 ;7
- 10 Vainiomäki S, Hyppönen H, Kaipio J, Reponen J, Vänskä J, Lääveri T. Electronic Patient Record systems evaluated by brand in 2014. Suom Laakaril 2014; 69 (49) 3361-3371
- 11 Vänskä J, Viitanen J, Hyppönen H. , et al. Doctors critical of electronic patient record systems. Suom Laakaril 2010; 65 (50–52): 4177-4183
- 12 Winblad I, Hyppönen H, Vänskä J. , et al. Electronic patient record systems evaluated by make of product: further development required in all cases. Suom Laakaril 2010; 65 (50–52): 4185-4194
- 13 Vänskä J, Vainiomäki S, Kaipio J, Hyppönen H, Reponen J, Lääveri T. Electronic Patient Record systems as physicians' tools in 2014: no significant changes in user experience reported by physicians. Suom Laakaril 2014; 69 (49) 3351-3358
- 14 Lääveri T, Vainiomäki S, Kaipio J. , et al. Assessment of private sector electronic Patient record systems in 2014. Suom Laakaril 2015; 70 (23) 1660-1667
- 15 Lääveri T, Winblad I, Hyppönen H, Reponen J, Viitanen J, Antila KJ. EPR systems in private sector assessed, receiving criticism but also praise. Suom Laakaril 2011; 66 (19) 1565-1571
- 16 Mamykina L, Vawdrey DK, Stetson PD, Zheng K, Hripcsak G. Clinical documentation: composition or synthesis?. J Am Med Inform Assoc 2012; 19 (06) 1025-1031
- 17 Victores AJ, Coggins K, Takashima M. Electronic health records and resident workflow: a time-motion study of otolaryngology residents. Laryngoscope 2015; 125 (03) 594-598
- 18 Street Jr RL, Liu L, Farber NJ. , et al. Provider interaction with the electronic health record: the effects on patient-centered communication in medical encounters. Patient Educ Couns 2014; 96 (03) 315-319
- 19 Reponen J, Kangas M, Hämäläinen P, Keränen N. Use of information and communications technology in Finnish health care in 2014. Current situation and trends. Terveyden ja hyvinvoinnin laitos (THL). National Institute for Health and Welfare. 2015 ;12.
- 20 Valvira. Health technology. 2015 ; Available at: http://www.valvira.fi/web/en/healthcare/health-technology . Accessed November 29, 2015
- 21 Nummi VM. Inadequacies are frequently reported. Suom Laakaril 2012; 930
- 22 Elovainio M, Vahtera J, Kivimäki M. Occupational justice and work force health. Kansanterveys 2006; (10) 10-11
- 23 Lindfors PM, Heponiemi T, Meretoja OA, Leino TJ, Elovainio MJ. Mitigating on-call symptoms through organizational justice and job control: a cross-sectional study among Finnish anesthesiologists. Acta Anaesthesiol Scand 2009; 53 (09) 1138-1144
- 24 Heponiemi T, Sinervo T, Vänskä J, Halila H, Elovainio M. Physicians' and nurses' problems in connecting work and family life. Sosiaalilääketieteellinen Aikakauslehti 2009; 46 (01) 14-22
- 25 Heponiemi T, Sinervo T, Räsänen K, Vänskä J, Halila H, Elovainio M. Health and well-being of Finnish physicians and registered nurses -project report. Raportteja/Sosiaali- ja terveysalan tutkimus- ja kehittämiskeskus 2008;(35)
- 26 Töyry S. . Burnout and self-reported health among Finnish physicians. Kuopion yliopiston julkaisuja D Lääketiede 2005(365)
- 27 Elovainio M, Heponiemi T, Vänskä J. , et al. How well are Finnish physicians in the 21st century?. Suom Laakaril 2007; 62 (20–21): 2071-2076
- 28 Aalto AM, Heponiemi T, Keskimäki I. , et al. Employment, psychosocial work environment and well-being among migrant and native physicians in Finnish health care. Eur J Public Health 2014; 24 (03) 445-451
- 29 Munyisia EN, Yu P, Hailey D. Does the introduction of an electronic nursing documentation system in a nursing home reduce time on documentation for the nursing staff?. Int J Med Inform 2011; 80 (11) 782-792
- 30 Carayon P, Wetterneck TB, Alyousef B. , et al. Impact of electronic health record technology on the work and workflow of physicians in the intensive care unit. Int J Med Inform 2015; 84 (08) 578-594
- 31 Hyppönen H, Hämäläinen P, Reponen J. Questionnaires of the 2014 eHealth and eWelfare surveys. 2015 ; Available at: http://urn.fi/URN:ISBN:978-952-302-563-9 . Accessed March 20, 2016
- 32 Kaipio J. Usability in healthcare: Overcoming the mismatch between information systems and clinical work. Helsinki, Finland: Department of Computer Science and Engineering, Aalto University; 2011
- 33 Kaipio J, Lääveri T, Hyppönen H. , et al. Usability problems do not heal by themselves: National survey on physicians' experiences with EHRs in Finland. Int J Med Inform 2017; 97: 266-281
- 34 Parmanne P, Ruskoaho J, Vänskä J. Labour market survey 2014. 2014
- 35 Harris P. The nurse stress index. Work Stress 1989; (03) 335-346
- 36 Kivimäki M, Lindström K. Job stress and well-being of care providers: development of a standardized survey instrument. Hoitotiede 1992; 4 (03) 115-124
- 37 Karasek R, Brisson C, Kawakami N, Houtman I, Bongers P, Amick B. The Job Content Questionnaire (JCQ): an instrument for internationally comparative assessments of psychosocial job characteristics. J Occup Health Psychol 1998; 3 (04) 322-355
- 38 Reuben DB, Knudsen J, Senelick W, Glazier E, Koretz BK. The effect of a physician partner program on physician efficiency and patient satisfaction. JAMA Intern Med 2014; 174 (07) 1190-1193
- 39 Martikainen S, Viitanen J, Korpela M, Lääveri T. Physicians' experiences of participation in healthcare IT development in Finland: willing but not able. Int J Med Inform 2012; 81 (02) 98-113
- 40 Martikainen S, Korpela M, Tiihonen T. User participation in healthcare IT development: a developers' viewpoint in Finland. Int J Med Inform 2014; 83 (03) 189-200
- 41 Heponiemi T, Sinervo T, Vänskä J, Halila H, Elovainio M. Job control and organisational justice in physicians' work. Suom Laakaril 2010; 65 (44) 3609-3614
- 42 Sumanen M, Heikkilä T, Hyppölä H. , et al. Physician 2013 study: Physicians are satisfied with their vocational choice. Suom Laakaril 2015; 70 (34) 2084-2089