70% of M.D.s Stressed by EHRs, Orthopedic Surgeons Hit Worst

Orthopedists as a group are suffering more stress from being metaphorically chained to electronic health records systems (EHRs) than any other specialty, a new study says.

Of 1,792 physicians who responded to a survey sent to all physicians practicing in Rhode Island, 70% said they were stressed by using their electronic health records systems, and 26% reported that they were burned out by their EHRs.

“Among the 15 most commonly reported specialties, the specialty with the highest prevalence of HIT-related (HIT = healthcare information technology) stress was orthopedic surgery (86.5%), followed by general internal medicine (86.0%) and family medicine (83.2%),” the report said.

When it came to “burnout” (the worst level of stress), “only” 23.9% of orthopedic surgeons were so categorized; the top of the burnout list was family medicine, 35.7%.

What is “burnout” as used in the study?

The EHR study used a question from a 2002 study, “The US Physician Worklife Study,” to define burnout. In that prior study, physicians were asked to rate whether they felt burned out on a scale of 1-5.  In the EHR study, a respondent is considered burned out if she or he answers yes to any of these three levels on the burnout scale: 3) “I am definitely burning out and have one or more symptoms of burnout, e.g., emotional exhaustion;” 4) “The symptoms of burnout I am experiencing won’t go away. I think about work frustrations a lot;” or 5) “I feel completely burned out. I am at the point where I may need to seek help.”

Just how bad is burnout?

The EHR study says, “Physicians who report burnout symptoms have higher rates of turnover, higher prevalence of substance use disorders, and more malpractice claims. Patients of burned-out physicians experience more errors, have lower satisfaction with their care, and experience more unnecessary tests and consultations. Healthcare systems bear higher costs when their physicians are burned out: replacing a physician costs anywhere from $250,000 to a million dollars, and burned-out physicians may have more absences and lower productivity.”

“Physicians have identified electronic health records (EHRs) as an important component in burnout, and dissatisfaction with one’s EHR is associated with intent to reduce clinical work hours and leave one’s current practice…computerized physician order entry was an important predictor of burnout in physicians’ electronic environment,” the EHR study says.

About 78% of the physicians in the survey said their EHRs improved billing, and 69.2% said they improved communications among physicians and staff.  However, only 51.9% said they improved patient care and only 48.6% said they improved clinical workflow.

Nearly 83% of responding physicians report using their EHRs remotely, which is bad:  the main reason, by far (59.7% of remote users) said the reason was their inability to finish documenting during working hours.

What to do about it?

“Potential interventions include scribes, team-based documentation with an enhanced role for medical assistants, ‘at-the-elbow’ EHR training, additional time to document during the work day, and streamlined documentation expectations.”

The trouble with additional time, of course, is that physicians aren’t paid for it. Other suggestions:

• Ban work-related emails while the physician is on vacation (which, the study says, would require changes so that the physician can be sure the patient is being cared for);
• Billing that does not rely on documentation;
• Inclusion of EHR users into the system design process;
• More intuitive user interfaces that are standardized across settings;
• Harmonized quality metrics, and
• Automated data collection that can pull from free text instead of fields and check boxes.

The EHR research, reported in the December 5, 2018 issue of theJournal of the American Medical Informatics Association(JAMIA), published by Oxford University Press USA, lists several authors, led by Rebekah L. Gardner of the Department of Medicine, Warren Alpert Medical School, Brown University, Providence, Rhode Island, and Healthcentric Advisors, Providence, Rhode Island. An abstracts is available.

An abstract or copy of the prior, 2002 Physician Worklife report (which might tell you a great deal about how your own level of stress compares with that of other physicians, is available online.