And burnout has widespread ramifications. When a physician leaves a provider organization prematurely—either because of burnout or for another reason—it can cost as much as $500,000 to $1 million in lost revenue, recruitment, and training. Burnout has also been associated with medical errors, reductions in care quality, and a high physician suicide rate (see the recent Health Affairs blog Physician burnout is a public health crisis: A message to our fellow health care CEOs, penned by 10 prominent CEOs in the industry). And while a new study suggests burnout rates may be improving, 44% of physicians surveyed still report symptoms of burnout.
EHR's role in burnout
In the midst of the maelstrom, the EHR—inextricably intertwined today with every aspect of patient care, payment, and health care operations—has become the posterchild for physician burnout and, perhaps too often, the center of the conversation. A 2017 Medscape survey of 14,000 physicians found three of the top five causes of physician burnout were associated with too much time spent in the EHR and specifically on bureaucratic tasks and documentation, with many physicians saying they spend several hours a day completing these tasks.
In addition, EHR usability issues are widespread. A 2015 Reaction Data study found that 54% of community hospital EHR users considered usability to be a major issue. Problems included screen displays with confusing layouts and extraneous information, redundant and burdensome workflows, and unnecessary alerts. Usability problems are also known to contribute to patient safety events.
How organizations can address EHR-related burnout
To address the EHR-related burnout, organizations must comprehensively review EHR governance practices and assess the degree to which the EHR is relied on for non-patient care goals (e.g., regulatory, quality improvement). Importantly, organizations must examine the role of EHR configuration in the context of practice workflow: The two are heavily intertwined, and changes to one directly affect the other.
When organizations configure the EHR during implementation or optimization, they should leverage basic principles of usability. EHR usability issues derive from:
- The characteristics of the system as delivered by the vendor;
- Local configuration decisions; and
- Clinicians' lack of familiarity with the system and how to work within it most efficiently.
However, the complexities of clinical practice—combined with the numerous configuration options of a modern EHR—create a conundrum: Where the EHR can make clinical practice more difficult, it is also hard to make clinical practice easy. To improve EHR configuration, organizations should rely on physician use patterns, qualitative and quantitative data from surveys, help-desk tickets, and user complaints. Optimization efforts require easy-to-use, fast, and effective communication channels between clinicians and system governance and maintenance so that barriers to efficiency and usability can be quickly identified and addressed. Regular, proactive outreach to clinicians about usability, as well as an ongoing and multifaceted approach to user training and continuous education, is essential to ensure optimal use of the system in the face of near-constant vendor updates and staff turnover.
A conscientious approach can yield exceptional results. For example, in 2018, Novant Health—thanks to strong physician leadership, a data-based approach to configuration, and ongoing physician education—achieved the KLAS Arch Collaborative's 99th percentile for physician satisfaction.
To help our members improve usability of their EHRs and avoid physician burnout, download a copy of "How to Address Clinician Burnout through EHR Optimization."
Member exclusive: Health Care IT Advisor members can now register for our 2019 Virtual Summit, including a 30-minute session, "EHR Optimization: A Prescription for Clinician Wellness," to be held on August 8 at 3pm ET. Review the full agenda and save your virtual seat today.
 Interview, Dr. Keith Griffin, Novant Healh Medical Group CMIO, Feb. 28, 2019