Doctors less satisfied, more burned out with electronic records

Most doctors who use electronic health records and order entry software tend to be less satisfied with how much time they spend on clerical tasks and are at higher risk of burnout than others, according to a new study.

Electronic health records – EHR for short - are “focused on documentation for billing as opposed to efficient and effective documentation of clinical care,” said Dr. Ann O’Malley of Mathematica Policy Research in Washington, D.C., who was not part of the new study.

This makes the EHR less useful for actual patient care, which can be frustrating for doctors, she told Reuters Health by email.

“EHR vendors need to work much more closely with practicing physicians, nurses and staff to better understand the functionalities they need from the record and how to make them more clinically relevant and user friendly,” O’Malley said.

“These electronic tools also give physicians access to the medical record when at home, which has extended the physician work day,” said lead author Dr. Tait D. Shanafelt of the Mayo Clinic in Rochester, Minnesota. “Studies suggest physicians spend more than 10 hrs/week interacting with the EHR after they go home from the office on nights and weekends.”

For doctors, burnout has been linked to decreased quality of care and medical errors, Shanafelt told Reuters Health by email.

He and his coauthors looked at survey responses collected in 2014 from U.S. doctors in all specialties. Almost 36,000 doctors were invited to participate and 6,880 responded, including 6,560 who were in active practice.

More than 80 percent said they used electronic health records (EHR) and a similar proportion said they used computerized physician order entry (CPOE), which allows them to enter medication orders or other instructions electronically.

After accounting for other factors like practice setting and hours worked per week, the doctors who used those tools were 33 percent less satisfied with how much time they spent on clerical tasks, and they had a 29 percent higher risk of burnout, compared to other doctors, as reported in Mayo Clinic Proceedings.

“Often healthcare is compared to the airline industry,” Palen said. “We don’t want pilots stressed out, we want them at their best ability.”

But electronic health records and digital tools aren’t necessarily the cause of the burnout, said Dr. Ted E. Palen of the Colorado Permanente Medical Group in Denver, who was not part of the new study.

“In my experience (they make) you more productive, and you’re doing more patient care in the sense that you’re managing more patients at one time because productivity increases,” Palen told Reuters Health by phone.

The old paper-based workflow was disjointed and had more lag time, he said.

“Patient access to the physician or team is much easier now,” he said. “Email traffic initiated by patients has gone up from three to four emails per day a decade ago to 10 to 20 emails per day.”

SOURCE: Mayo Clinic Proceedings, online June 27, 2016.