Electronic health records: failing and causing physicians to fail too
The results of a recent study suggest that despite promises the digitization and transition to electronic health records (EHRs) would benefit both patients and physicians, healthcare professionals are in fact suffering EHR-related burnout and rate the usability of EHRs very poorly.
Healthcare professionals employ various electronic health record (EHR) systems to digitally manage patient information; EHRs digitally store all patients’ clinical data and, in theory, allow for more integrated, accurate, interdisciplinary and rapid care provision. However, the results of a new collaborative study, by investigators from Yale University (CT, USA), Stanford University (CA, USA), the Mayo Clinic (MN, USA) and the American Medical Association (IL, USA), demonstrate that physicians consider the usability of EHRs to be very poor, which may contribute to physician burnout.
In 2009, the passage of the Health Information Technology for Economic and Clinical Health Act provided US$27 billion for the incentivization of the widespread adoption of EHRs across the USA. This forced healthcare professionals to rapidly adapt to complex user systems, leading to much physician frustration.
In this study, researchers investigated the physician-perceived usability of EHRs, as defined by a standardized metric of technology usability, allowing investigators to evaluate the association between EHR usability and physician burnout.
Every 3 years, the American Medical Association surveys more than 5,000 healthcare professionals with the Maslach Burnout Inventory – a cross-sectional survey used to evaluate topics related to physician burnout. Most recently, the physician burnout rate was estimated to be 43.9% – this is significantly greater than that of the wider US general population burnout rate of 28.6%.
A random subset of 1250 Maslach Burnout Inventory survey respondents were also asked to rate the usability of the EHR(s) they routinely employ; EHR usability was assessed via the System Usability Scale and scores were normalized to percentile rankings.
In the study, the mean EHR usability rating was 45/100; this is significantly lower than usability scores reported for Google and Microsoft Word, for example, as detailed in similar studies.
More detailed study analysis revealed that EHR usability scores were particularly low amongst physicians of certain specialties – including dermatology, and orthopedic and general surgery. By contrast, physicians who worked in fields such as anesthesiology and general pediatrics rated their EHR's usability higher.
However, irrespective of physicians’ specialties, lower EHR usability scores were consistently correlated with increased physician burnout.
Edward Melnick, (Yale University), commented: “We're trying to improve and standardize EHRs. The goal is that with future work, we won't have to ask doctors how they feel about the EHR or even how burned out they are, but that we can see how doctors are interfacing with the EHR and, when it improves, we can see that improvement.”
Melnick ER, Dyrbye LN, Sinsky CA et al. The association between perceived electronic health record usability and professional burnout among US physicians. Mayo Clin Proc. doi:org/10.1016/j.mayocp.2019.09.024 (2019) (Epub ahead of print);