3 Key Strategies to Mitigate Health IT, EHR Clinician Burnout

Clinician burnout can be mitigated by health IT and EHR optimization, EHR training, and care team expansion, according to a study published in the Journal of the American Medical Informatics Association (JAMIA).

Furthermore, other burnout factors such as physician specialty, practice setting, regulatory pressures, and how physicians spend their time can affect clinician burnout rates.

“Arguably, the primary drivers of burnout for physicians have been related to electronic health records and overwhelming inefficiencies in clinical practice that significantly and negatively impact workflow and patient care,” wrote the study authors. “Physicians experience high fatigue with short, continuous periods of EHR use, which is also associated with inefficiency of EHR use (ie, more clicks and more time) on subsequent cases.”

Because EHR design and usability are both leading causes for clinician burden, the study authors conducted a systematic review of multiple databases in 2018 and 2020 to identify potential workplace interventions to mitigate burnout. While many researchers have assessed the cause of burnout in the past, there’s been little evidence about mitigation strategies.

Of the nearly 5,000 pieces of literature, 81 met inclusion criteria, which the study authors categorized as the “4Ts framework: technology, time, teamwork, and transitions.”

These studies found mitigating clinician burnout could be achieved by optimizing the EHR, providing training, reducing EHR documentation, expanding the care team, and leveraging the quality improvement processes in the workflows. Overall, 68 percent of these studies reported clinician burnout improvement.   

“The impact of digital technologies on how physicians spend their time has been shown to affect multiple key domains including productivity and revenue, job and patient satisfaction, and personal well-being,” wrote the study authors.

The research team looked at the disproportionate use of health IT and EHRs by physician specialties and practice settings. The authors noted specialties such as cardiology, urology, and family practice have demonstrated higher EHR use than other specialties.

To help those specialties, the study authors learned integration of communication systems has shown improvements in reporting times and information availability.

“This review identified several interventions to decrease digital tool use and potentially redirect time for face-to-face patient contact and improvements in work-life balance; many of those studies performed time and motion analyses to understand the impact of workflow modification on physicians’ time by proxy of measuring the duration of digital tool task completion,” wrote the researchers.

Quality EHR training is essential to provider users, especially those new to the technology. An effective EHR training program, especially for new systems or documentation requirements, can reduce the likelihood of clinician burden and boost satisfaction.

Every study identified showed EHR and health IT optimization improved clinician burnout rates and usability. However, EHR adoption and implementation had little impact or added to clinician burnout. The researchers found there are strong justifications for healthcare organizations to optimize EHR usability and documentation for accurate use cases.

‘Until the arrival of policy reform, practical and effective workflow interventions should be leveraged to reduce excessive data entry by the physician,” wrote the study authors.

The literature showed the vast amount of information that clinicians are required to handle should result in care team expansion, including human scribes. An expanded care team could also manage and monitor the EHR inbox, including patient portals and prescription refill requests. Clinicians could also delegate EHR documentation efforts to other members of the care team.

“Interventions designed to optimize technologies, training, and workflows may shift physician burnout to resilience,” concluded the study authors. “Factors that contribute significantly to the burden of the digital environment in healthcare include clinical specialty, practice setting, requirements for compliance and reimbursement, and how physicians spend their time.”