Heavy EHR Workload Leads to Higher Clinician Burnout, Exhaustion

One-third of clinicians experienced high cynicism and over half reported high exhaustion levels that were directly caused by extensive EHR use, according to a study published in the Journal of the American Medical Informatics Association (JAMIA).

The study, which included a survey of 87 clinicians, found that clinicians who had greater than 307 EHR messages per week had 6.17 greater odds of experiencing high-level exhaustion and clinician burnout.

Numerous studies have shown that EHRs are the primary cause of clinician burnout.

“Burnout is ‘a psychological syndrome emerging as a prolonged response to chronic interpersonal stressors on the job’ and is a top policy priority given concerns about the potential impact on the well-being of the clinician workforce as well as potential adverse impacts on patient care,” explained the authors of the study.

“A recent survey study found that 70 percent of clinicians reported experiencing stress related to the use of health information technology and that such stress was independently predictive of burnout,” they continued. “In particular, time spent on documentation and time spent on EHRs at home were cited as key contributors to burnout.”

Researchers conducted this study in an attempt to understand the relationship between EHR use and two components of burnout: cynicism and exhaustion.

The study poled clinicians from 10 primary care practices at a large academic health system in San Francisco, CA and tracked the Provider Efficiency Profile (PEP) measures of the clinicians over a four-week time period.

The PEP measures how clinicians are spending their time with the EHR, from the amount of time spent working on the EHR to which EHR tools are being utilized.

Researchers captured the minutes active after hours on days of scheduled clinic sessions, the minutes active at any time on non-clinic session days, the volume of EHR messages received, clinician EHR proficiency, and clinician EHR efficiency.

In total, the researchers examined 10 models using the five models to test both exhaustion and cynicism.

Of the 87 clinician respondents, 13 percent had permanent scribes to aid EHR documentation. Over 60 percent reported having good or optimal EHR proficiency, while only 17 percent reported modest burden of time spent at home utilizing the EHR.

Researchers found that 34 percent of clinicians suffered high cynicism, while 51 percent reported high exhaustion. They also found that clinicians spent an average of 1.92 hours in the EHR on scheduled clinic days and 7.52 hours on unscheduled clinic days.

On average, the respondents handled 229 messages in the EHR on a weekly basis.

Researchers found direct correlations between lower EHR proficiency and increased EHR usage. They also found a correlation between message volume and time spent in the EHR.

Furthermore, clinicians who spent more time on scheduled days after hours also spent more time on unscheduled days and were also more proficient, but were less efficient.

This is yet another example that shows how an increased EHR workload has a direct correlation to clinician burnout and reducing the EHR workload would be a step in the right direction of lessening burnout and stress.   

“Our study brings important empirical evidence to the widely asserted contribution of EHRs to clinician burnout,” wrote the authors. “We found that 2 objective, vendor-defined measures of EHR use—time spent after hours on the EHR and volume of inbox messages—are related to exhaustion.”

“These measures are amenable to intervention by rethinking the division of EHR documentation across primary care teams,” they concluded. “Our results therefore serve to guide policy and practice efforts to design EHR systems and clinical workflows that improve outcomes for patients without unintentionally harming the clinicians who care for them.”