Clinical process design and clinical culture are two driving forces behind the spike in stress and burnout medical professionals associate with maintaining EHRs, according to Albuquerque-based University of New Mexico researchers.
For the research project, UNM worked with Stanford University, University of Minnesota, Minneapolis-based Hennepin County Medical Center and Centura Health System in Centennial, Colo. The research team surveyed 282 clinicians on EHR design and use factors associated with stress and burnout.
The survey included validated measures of stress, burnout and the likelihood to discontinue practicing medicine from a prior focus group study that identified EHR design and use factors that physicians blamed for stress and burnout. The UNM survey measured how strongly participants felt the previously identified EHR design and use factors affected stress and burnout.
Participants were asked how issues such as excessive data entry, inability to navigate the system quickly and barriers to note documentation affected their work time.
Survey results showed that 13 percent of physician self-reported levels of stress and burnout were directly related to EHRs. However, that percentage does not reflect the "complete story," which is that clinical process design and the clinical culture, both impacted by the EHR, contribute to approximately 40 percent of clinician stress, said Philip Kroth, MD, according to the report. Dr. Kroth is director of biomedical informatics research, training and scholarship at UNM.
Increased data entry requirements for elements including potential medical malpractice, quality assurance initiatives, support for billing processes and government policy oversight processes have added extra administrative work for physicians, deviating from EHRs intended purpose of documenting patient history, Dr. Kroth said.
"It seems as though everyone wants to add another checkbox or drop-down to the record, but no one is looking at the sum total of how all these additional data entry requirements are adding up or whether they actually benefit the patient or the healthcare system," he said. "In many ways, it isn't even valid to compare the old paper charts with today's EHRs that require so much more information to be included."
Survey respondents did say they liked having access to updated patient medical records remotely but did not favor how at-home access can easily add hours to their workday.