Can better EHR training reduce physician burnout?
Organizations can take a number of steps to reduce the negative impact EHRs have on their physicians and improve satisfaction. KLAS Research’ s Arch Collaborative provides tips for successful EHR training and support.
The topic of physician burnout has received a lot of attention. The COVID-19 pandemic has added immense pressure and stress to what was already a challenging career, leading to longer shifts, limited resources and increased risk for frontline workers.
But burnout had been affecting healthcare organizations long before COVID-19.
In 2017, 44 percent of surveyed physicians reported symptoms of burnout. Physician burnout can impact patient care and increase the risk of medical mistakes. It can also lead to physicians leaving the medical field. In 2018, the AMA estimated that the U.S. economic impact of physician burnout was $4.6 billion per year.
EHRs: A leading cause of physician burnout
There are many causes of physician burnout, such as too many administrative tasks, not having enough time with patients and working too many hours. But the increased use of electronic health records is a critical factor. The 2018 Harris Poll conducted by Stanford Medicine found that seven in 10 physicians agree that “EHRs contribute greatly to physician burnout.”
While they are very effective tools, EHR systems are complex applications that can be difficult for users to learn.
To make matters more challenging for users, EHR systems are subject to frequent updates, upgrades and changes required for federal compliance. But most importantly, time spent in EHRs is time spent away from patients. The Harris Poll also found that physicians spend an average of 31 minutes on each patient encounter, 19 of which are spent in the EHR system.
Time spent in EHRs doesn’t just cut into the time physicians spend with their patients; it also means less time spent at home. More than 70 percent of physicians surveyed in the Harris Poll agree that “using an EHR has increased the total number of hours I work on a daily basis.”
A recent study published by the Journal of the American Medical Informatics Association identified a direct correlation between time spent on after-hours charting and self-reported burnout among physicians. It found that physicians who spent five or fewer hours of weekly after-hours charting were twice as likely to report lower levels of burnout than those who spent six or more hours. Some 43 percent of physicians in the study reported spending six or more hours per week on after-hours charting, indicating that EHR fatigue is a leading cause of physician burnout.
Can better EHR training reduce burnout?
Organizations can take a number of steps to reduce the negative impact EHRs have on their physicians and improve satisfaction.
Studies show that the quality of training physicians receive has far more impact on their satisfaction with the EHR system than the system itself. The JAMIA study found that physicians “who agree that their organization has done a great job with EHR implementation, training and support were also twice as likely to report lower levels of burnout than those who disagreed.”
When looking for ways to reduce physician burnout, improving EHR training and support offers hope. The focus must be on increasing satisfaction, usability and proficiency.
Tips for successful EHR training and support
KLAS Research’s Arch Collaborative serves as an expert in guiding EHR training and support efforts for healthcare organizations. Based on its findings and the experience of healthcare organizations, here are seven tips for successful EHR training and support.
1. Invest in EHR training and onboarding from the start.
Don’t cut corners on the initial training program. While ongoing training and support should play a vital role in your overall training strategy, research suggests that the quality of initial EHR education is the single most important factor in determining end-user satisfaction.
The Arch Collaborative recommends asking the following questions to self-assess current training programs:
- Would I enjoy going through our existing training programs?
- Do we expect all new clinicians to go through 7 or more hours of initial training?*
- Are our training opportunities in high demand?
(*Data indicates that providing at least 7 hours of initial EHR education correlates with higher satisfaction scores. Breaking this training up into blocks makes it most effective.)
2. Consider going digital.
Does seven or more hours in a classroom sound like too much? Consider switching to a hybrid training model that utilizes digital learning tools.
Virtual training provides many benefits. It can make your training strategy more agile, optimizing it for dealing with turnover and scaling for growth. It can also save money on instructor-led classroom training and reduce onboarding time.
When Gundersen Health System incorporated an electronic training platform as part of their new hybrid approach to training, it reduced EHR onboarding time by 66 percent. “We provide at-the-elbow customization and personalization, which we have found is the most beneficial time spent with clinicians. They have told me many times that this model is so much better than sitting through an eight-hour class,” says Polly Berendes, advanced training consultant at Gundersen.
3. Make ongoing training opportunities available.
Research also suggests that ongoing EHR training correlates with higher satisfaction scores.
The Arch Collaborative recommends about three to five hours per year of ongoing training. Ongoing training and support provide a refresher on infrequent tasks and can help identify areas for improvement. Clinicians who attend ongoing training estimate that it saves them over two hours of time per week in the EHR.
By leveraging an electronic training platform to provide ongoing training opportunities in the workflow, Baylor Scott & White Health (BSW) improved EHR satisfaction.
4. Deliver role-specific training content.
Nobody wants to sift through information that is not relevant to them. Kelley Williamson, director of IT for UC Health, notes: “Burnout is huge in organizations. … If a change or an upgrade does happen, our clinicians need to know what those changes are … and whether or not it affects them.”
Her observations are consistent with those of the Arch Collaborative, which found that workflow-specific training material correlates with higher EHR satisfaction.
5. Offer users just-in-time support within their workflow.
People begin forgetting what they’ve learned as soon as they finish training. Just-in-time learning materials within the workflow allow EHR users to get the help they need when and where they need it most. After implementing an electronic training platform, Derek Harley, learning and development system manager at M Health Fairview says, “I think that is where the future of learning is right now - giving end-users short bites of content when they need it, in a way that works for them.”
Just-in-time support can also reduce time users spend searching for help when they get stuck. Users of one electronic training platform report a 40 percent reduction in help desk calls and a 15 percent increase in user efficiency.
6. Make your content more accessible with multiple formats.
Give your users training content in the format they prefer. Everyone learns differently, so it is important to offer a variety of training methods to your end users. For digital training, consider tools that allow for the quick creation and delivery of multiple learning formats, such as tip sheets, videos and simulations. Users report that an electronic training platform with content creation tools speeds up authoring time across multiple platforms by 50 percent.
7. Keep it centralized.
Make it easier for both learners and content creators by investing in software that offers centralized content management and distribution across multiple systems. For creators, this means fewer dashboards to manage, expediting the authoring and distribution of content. For users, this means always knowing where to go to find the help they need.
It also adds credibility to the content you share. When discussing the benefits of an electronic training platform for UCHealth, Kelley Williamson emphasizes: “Everything was everywhere for training, and there were many different places that things were being created, so having one source of truth at everybody’s fingertips was very, very important to us.”
Jordan Edwards is marketing manager at uPerform.
See related story: Combating clinical staff turnover with an effective EHR training strategy