Increased EHR Workload Has a Major Impact on Clinician Burnout

EHR usability and clinician workload have a strong impact on clinician burnout, while task load serves as a connector between EHR usability and clinician burnout, according to a study published in the Journal of Medical Internet Research.

Boosting EHR usability while decreasing task load, such as mental, physical, and temporal demand for a clinician, can allow practicing clinicians to decrease cognitive burden, which then allows for better patient care and improved decision making

There is a growing connection between EHR usability 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.

The researchers surveyed 848 physicians from all specialties and utilized the System Usability Scale (SUS) scoring system, which is based on a 100-point scale, to determine a link between EHR usability and clinician workload based on specialty and practice setting.

Researchers also determined provider task load (PTL) using the National Aeronautics and Space Administration Task Load Index, which was on a 400-point scale.

The respondents' average score was a 46.1 for SUS (68 is an average benchmark response) and 262.5 for PTL. When researchers adjusted based on age, gender, relationship status, medical specialty, practice setting, hours worked per week, and the number of nights on call per week, the results showed a 1-point increase in SUS score and a 0.57 decrease in PTL score. Researchers also found a higher SUS score was associated with a lower PTL score, which was also associated with lower chances of burnout. Thus, physician-perceived EHR usability scores have a strong connection with physician daily task load.

“Despite the strong statistically significant associations found, the amount of variability in PTL as a measure of workload explained by EHR usability was small,” the study authors wrote. “This finding indicates that factors other than EHR usability appear to be the primary drivers of physician workload as assessed by the mental demand, physical demand, temporal demand, and effort required subscales of the NASA-TLX.”

When accounting for age, gender, medical specialty, hours worked per week, number of nights on call per week, and practice setting, there was a 30 percent decrease in the chance of burnout on the PTL scale. Furthermore, the 18-point SUS score increase would give the EHR a ‘D’ grade, which is only slightly better than the average usability score of Microsoft Excel, the study authors cited.

Additionally, there is a strong relationship between EHR usability and PTL by physician specialty. Specialties with a higher task load, such as anesthesiology and dermatology, reported higher EHR usability scores, while those with a lower task load, such as orthopedic surgery and family medicine, rated their EHR usability less favorably.

As a result, researchers suggested the relationship between EHR usability and task load may not relate to physicians in specialties with a higher task load rating.

“Efforts to address physician burnout should attend to both improving EHR usability and addressing other drivers of task load, particularly extraneous load,” concluded the study authors.

“Improving EHR usability while decreasing extraneous task load has the potential to allow practicing physicians more available working memory for medical decision making and patient communication. Specific areas to target could include consolidating the display of related information, reducing redundancy of information, and increasing standardization.”