Study links stress from EHR use to physician burnout

Doctor use of electronic health records is causing stress that is strongly associated with physician burnout, according to a new study.

That’s the conclusion of an analysis of results from a 2017 Rhode Island Department of Health survey in which 4,197 practicing physicians in the state were surveyed on their EHR use.

Of the 1,792 doctors who responded to the survey (a 43 percent response rate), 26 percent reported experiencing physician burnout.

Researchers at Brown University’s Warren Alpert Medical School and other organizations conducted the analysis of the survey results, which were published on Wednesday in the Journal of the American Medical Informatics Association.

The study focused on three health IT-related stress measures: whether the EHR adds to the frustration of a physician’s day, sufficiency of time for documentation and the amount of time doctors spent on the EHR at home.

“Among EHR users (91 percent), 70 percent reported HIT-related stress, with the highest prevalence in primary care-oriented specialties,” state the study’s authors. “After adjustment, physicians reporting poor/marginal time for documentation had 2.8 times the odds of burnout, compared to those reporting sufficient time. Physicians reporting moderately high/excessive time on EHRs at home had 1.9 times the odds of burnout, compared to those with minimal/no EHR use at home. Those who agreed that EHRs add to their daily frustration had 2.4 times the odds of burnout, compared to those who disagreed.”

Also See: EHRs get most blame for epidemic of physician burnout

Overall, what researchers found was that HIT-related stress was measurable, prevalent and specialty related.

According to the study, more than a third of primary care physicians reported all three measures of EHR-related stress, including general internists (39.5 percent), family medicine physicians (37 percent), dermatologists (36.4 percent) and pediatricians (33.6 percent).

On the low end of the scale were radiologists (1.7 percent) who reported all three measures of HIT-related stress, followed by anesthesiologists (2.7 percent) and hospitalists (5.6 percent).

Despite the fact that family medicine physicians (35.7 percent) and dermatologists (34.6 percent) reported the highest levels of burnout, hospital medicine specialists (30.8 percent) placed third.

“In this paper, we show that EHR stress is associated with burnout, even after controlling for a lot of different demographic and practice characteristics,” said Rebekah Gardner, MD, an author of the study and associate professor of medicine at Brown University’s Warren Alpert Medical School. “Quantitatively, physicians who have identified these stressors are more likely to be burned out than physicians who haven’t.”

Among the three HIT-related stress measures, insufficient time for documentation most strongly predicted burnout symptoms—with about half of physicians reporting insufficient time for documentation, according to the study.

“Based on our results and the work of others, we recommend that healthcare organizations regularly and systematically measure HIT-related stress and burnout among their workforce,” state the authors.

At the same time, Gardner emphasized that while the study shows an “association” between stress from using EHRs and physician burnout she could not definitively say from the survey data that it is causal.

Gardner also acknowledged that one of the limitations of the doctor survey is that it was not anonymous and was administered by the Rhode Island Department of Health, which is responsible for licensing physicians in the state.

Doctors “may not have felt comfortable expressing their level of burnout,” she concludes. “We do think there’s probably an under-reporting of the problem.”