EHR Multitasking Causes and How to Improve Clinician Burnout

Clinicians and continuing medical education individuals both suggested EHR multitasking as a direct cause of EHR errors and clinician burnout, according to a study published in JMIR Publications.

The researchers found a growing connection between EHR usability, extended EHR use, and clinician burnout. EHR usability issues typically result in an increase in cognitive load and errors, which can lead to patient safety issues. An increase in cognitive load adds to EHR use, which then leads to clinician burnout.

According to the study authors, clinicians spend one-third of outpatient visits using the EHR, either in silence or by multitasking on the EHR. A common example of EHR multitasking is when a clinician is listening to a patient while ordering a prescription. Multitasking can also result in patient safety and clinician burden.

The research team conducted two workshops and a lecture with roughly 60 continuing medical education participants about EHR multitasking and how it impacted usability and burnout.

The workshops discussed memorable times that the user multitasked and either had “misses,” EHR errors that were not caught at the time, or “near-misses,” mistakes caught before an error occurred. The group also discussed strategies to boost EHR safety during multitasking.

Respondents said the computer’s location, EHR usability, patient data overload, clinical style and content, computer system issues, and patient and provider communication behaviors were common multitask risk factors.

To fix these issues, the respondents came up with several strategies to reduce EHR multitasking misses and improve EHR safety. These included adapting visit organization and workflow, clinician transparency during prescribing, improving EHR system design, improving team support, narrating EHR use, and activating the patient during EHR use.

“Clinicians need practical intrapersonal, interpersonal, and systems strategies to use EHR systems in mindful, relational ways,” explained the researchers. “Avoiding all EHR use during patient encounters may be impossible and unsustainable, with clinicians using EHR systems over half of their workday and increasingly after clinic hours.”

“Meanwhile, research suggests that the risk of EHR multitasking is affected by the cognitive complexity of tasks and decisions, EHR system usability, teamwork, and clinician-patient dynamics,” they added.

Furthermore, the researchers explained that clinician transparency with patients about EHR systems, such as the required focus it takes to prescribe, could mitigate EHR errors and increase patient safety.

“As professional schools implement skills-based training in patient-provider communication with EHR system use, trainees may be able to practice empathic ways to negotiate the need for silent EHR use and ways to detect subtle queues from patients signaling that they need the clinician’s full attention,” the researchers said.

EHR systems and health IT systems are constantly evolving. But while technology aims to help clinicians complete daily tasks, usability problems tend to arise. Although these problems sometimes occur at implementation, clinicians often encounter EHR usability issues during EHR optimization.

The research team recommended both proactive and reactive methods to reduce technological errors, such as system walkthroughs, case studies, computer-based simulations, experimental evaluation, usability testing, and rapid assessment processes.

The study authors noted study limitations, such as a small sample size of participants and a limited number of participant characteristics. For instance, although the study participants included clinicians and healthcare professionals from non-academic settings, most of the participants were academically-based clinician-educators, clinician administrators, and clinician-researchers.

The authors said the addition of nurses and clinicians from nonacademic facilities could offer a range of perspectives.  

“Future studies should explore diverse patient perspectives about clinicians’ EHR multitasking and their strategies for bringing clinicians ‘back to the present,’ concluded the research team. “In addition, studies should examine how these strategies affect patient-important outcomes in quality and safety.”