Electronic Health Record Alert-Related Workload as a Predictor of Burnout in Primary Care Providers

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Summary

Background: Electronic health records (EHRs) have been shown to increase physician workload. One EHR feature that contributes to increased workload is asynchronous alerts (also known as inbox notifications) related to test results, referral responses, medication refill requests, and messages from physicians and other health care professionals. This alert-related workload results in negative cognitive outcomes, but its effect on affective outcomes, such as burnout, has been under-studied.

Objectives: To examine EHR alert-related workload (both objective and subjective) as a predictor of burnout in primary care providers (PCPs), in order to ultimately inform interventions aimed at reducing burnout due to alert workload.

Methods: A cross-sectional questionnaire and focus group of 16 PCPs at a large medical center in the southern United States.

Results: Subjective, but not objective, alert workload was related to two of the three dimensions of burnout, including physical fatigue (p = 0.02) and cognitive weariness (p = 0.04), when controlling for organizational tenure. To reduce alert workload and subsequent burnout, participants indicated a desire to have protected time for alert management, fewer unnecessary alerts, and improvements to the EHR system.

Conclusions: Burnout associated with alert workload may be in part due to subjective differences at an individual level, and not solely a function of the objective work environment. This suggests the need for both individual and organizational-level interventions to improve alert workload and subsequent burnout. Additional research should confirm these findings in larger, more representative samples.

Citation: Gregory ME, Russo E, Singh H. Electronic health record alert-related workload as a predictor of burnout in primary care providers. Appl Clin Inform 2017; 8: 686–697 https://doi.org/10.4338/ACI-2017-01-RA-0003

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Most cited references 20

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Linda Aiken (2002)

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Resident burnout.

Niku K. Thomas (2004)

Intense work demands, limited control, and a high degree of work-home interference abound in residency training programs and should strongly predispose resident physicians to burnout as they do other health care professionals. This article reviews studies in the medical literature that address the level of burnout and associated personal and work factors, health and performance issues, and resources and interventions in residents. MEDLINE and PubMed databases were searched for peer-reviewed, English-language studies reporting primary data on burnout or dimensions of burnout among residents, published between 1983 and 2004, using combinations of the Medical Subject Heading terms burnout, professional, emotional exhaustion, cynicism, depersonalization and internship and residency, housestaff, intern, resident, or physicians in training and by examining reference lists of retrieved articles for relevant studies. A total of 15 heterogeneous articles on resident burnout were thus identified. The studies suggest that burnout levels are high among residents and may be associated with depression and problematic patient care. However, currently available data are insufficient to identify causal relationships and do not support using demographic or personality characteristics to identify at-risk residents. Moreover, given the heterogeneous nature and limitations of the available studies, as well as the importance of having rigorous data to understand and prevent resident burnout, large, prospective studies are needed.

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Is the professional satisfaction of general internists associated with patient satisfaction?

Jennifer Haas, E. Francis Cook, Ann Puopolo … (2000)

The growth of managed care has raised a number of concerns about patient and physician satisfaction. An association between physicians' professional satisfaction and the satisfaction of their patients could suggest new types of organizational interventions to improve the satisfaction of both. To examine the relation between the satisfaction of general internists and their patients. Cross-sectional surveys of patients and physicians. Eleven academically affiliated general internal medicine practices in the greater-Boston area. A random sample of English-speaking and Spanish-speaking patients (n = 2,620) with at least one visit to their physician (n = 166) during the preceding year. Patients' overall satisfaction with their health care, and their satisfaction with their most recent physician visit. After adjustment, the patients of physicians who rated themselves to be very or extremely satisfied with their work had higher scores for overall satisfaction with their health care (regression coefficient 2.10; 95% confidence interval 0.73-3.48), and for satisfaction with their most recent physician visit (regression coefficient 1.23; 95% confidence interval 0.26-2.21). In addition, younger patients, those with better overall health status, and those cared for by a physician who worked part-time were significantly more likely to report better satisfaction with both measures. Minority patients and those with managed care insurance also reported lower overall satisfaction. The patients of physicians who have higher professional satisfaction may themselves be more satisfied with their care. Further research will need to consider factors that may mediate the relation between patient and physician satisfaction.

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Author and article information

Journal

Journal ID (nlm-ta): Appl Clin Inform

Journal ID (iso-abbrev): Appl Clin Inform

Journal ID (doi): 10.1055/s-00035026

Title: Applied Clinical Informatics

Publisher: Schattauer GmbH

ISSN (Electronic): 1869-0327

Publication date (Print): July 2017

Publication date (Electronic): 20 December 2017

Volume: 8

Issue: 3

Pages: 686-697

Affiliations

[1 ] Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, TX

[2 ] Section of Health Services Research, Department of Medicine, Baylor College of Medicine, Houston, TX

Author notes

Correspondence to Megan E. Gregory, Ph.D. Center for Innovations in Quality, Effectiveness and Safety Michael E. DeBakey VA Medical Center Baylor College of Medicine 2450 Holcombe Blvd Suite 01Y Houston Texas 77021 (713) 794–8601 ext. 10232 megan.gregory@ 123456bcm.edu

Article

Accession ID: PMC6220682 Pmcid ID: PMC6220682 Pmc-uid ID: 6220682

DOI: 10.4338/ACI-2017-01-RA-0003

PMC ID: 6220682

PubMed ID: 28678892

SO-VID: 8a8d2c43-e542-47df-8b22-814b478496c5

History

Date received : 03 January 2017

Date accepted : 21 April 2017

Funding

Funded by: VA National Center for Patient Safety, and the Agency for Health Care Research and Quality

Award ID: (R01HS022087 and R21HS023602)

Funding The research reported here was supported in part by the U.S. Department of Veterans Affairs, Veterans Health Administration, Health Services Research and Development Service, Office of Academic Affiliations, Health Professions Education Evaluation and Research Advanced Fellowship and in part by Center for Innovations in Quality, Effectiveness and Safety (CIN 13–413), Michael E. DeBakey VA Medical Center, Houston, TX.

Dr. Singh is additionally supported by the VA Health Services Research and Development Service (CRE 12–033; Presidential Early Career Award for Scientists and Engineers USA 14–274), the VA National Center for Patient Safety, and the Agency for Health Care Research and Quality (R01HS022087 and R21HS023602). The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the U.S. Department of Veterans Affairs or the United States government.

Electronic Health Record Alert-Related Workload as a Predictor of Burnout in Primary Care Providers

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