With clerical demands of EHRs and
after-hours access, burnout abounds

So far, EHRs are only making things harder for physicians: report

July 01, 2016
by John W. Mitchell, Senior Correspondent
A study conducted by the Mayo Clinic concluded that the demands of electronic health records (EHR) — particularly the computerized physician order entry (CPOE) component necessary for every step of patient care — is stressing out already overburdened physicians.

“After adjusting for age, sex, specialty, practice setting, and hours worked per week, physicians who used an EHR and CPOE were 30 percent less likely to be satisfied with clerical burden,” Dr. Tait Shanafelt, Mayo Clinic physician and lead author, told HCB News. “With respect to burnout, computerized physician order entry appears to be a driving factor.”

According to Shanafelt, the administrative burden of CPOE — in which doctors place orders for patient procedures such as imaging exams and lab tests — is especially burdensome for doctors. CPOE replaced the long-standing process of written or verbal orders to nurses that sometimes resulted in miscommunication resulting in medical errors.

Also, because doctors can access medical charts remotely, physicians are putting in longer hours.

“Studies suggest physicians spend more than 10 hours a week interacting with the EHR after they go home from the office on nights and weekends,” explained Shanafelt.

He said the relationship between job dissatisfaction and EHR was most prominent among family medicine, urologists, otolaryngologists and neurologists.

“Physician burnout has been linked to medical errors and decreased quality of care as well as an increase in the likelihood physicians will cut back their work hours or leave the profession,” said Shanafelt. “These findings suggest burnout undermines the very foundation of our health care delivery system with impacts on quality, safety, patient satisfaction, and access to care.

Still, EHRs aren't going anywhere. According to Shanafelt, the solution is to shifting the clerical workload from the doctors to other staff members. This includes more use of nurses, medical scribes and other support staff to respond to electronic messages from patients. He added that some verbal communication with support staff should be permitted in lieu of electronic messaging.

The study — conducted in collaboration with the American Medical Association — was conducted in 2014 and a total of 6,560 physicians from all specialties in active practice participated in the study.

“The electronic environment of the U.S. health care system is rapidly evolving. Few studies, however, have evaluated the effect of these changes on physicians,” reported Shanafelt.