By Kate Monica
– Algorithms built into EHR systems designed to generate inbox messages may be partly responsible for rising rates of physician burnout, according to a July Health Affairs study.
A group of researchers led by University of California San Diego professor Ming Tai-Seale analyzed survey, administrative, and EHR data from the Palo Alto Medical Foundation to determine whether EHR workload affects physician burnout.
The California-based, multi-specialty healthcare organization has used Epic EHR since 1999. As part of the study, all physicians in primary and specialty care were asked to fill out a confidential one-page survey in 2016. Of a total of 1,292 physicians, 934 submitted responses.
The team used separate logistic regression analyses to measure the relationship between physician burnout and inbox volume.
“We included the variable that is potentially more modifiable by health system policy on physician work — that is, above-average numbers of system-generated in-basket messages — in the logistic and linear regression models,” explained researchers in the study report.
Researchers found that 36 percent of responding physicians reported experiencing symptoms of burnout, while 29 percent reported an interest in reducing their work time in the next year.
Despite these findings, the average life satisfaction score for participating physicians was relatively high at 78.22 out of 100.
“It is noteworthy that only 12 percent of respondents deemed the statement “physicians are highly valued” to be completely true regarding conditions in their primary practice setting,” wrote researchers.
Researchers determined the average number of weekly inbox messages among respondents was 243. Nearly half of these messages were generated by the EHR system.
“These included pending orders automatically sent to physicians according to algorithm-driven health maintenance reminders, requests for prior authorization, patient reminders, and many more,” researchers noted.
“Only 30 messages per week were directly from patients. Fifty-three were from other physicians or care team members, and 31 were from the physicians themselves (for example, reports of laboratory tests they had ordered),” the team wrote.
Overall, 42 percent of physicians received higher-than-average numbers of messages. EHR-generated messages were the single largest source of messages across specialties, especially for physicians in internal and family medicine.
Receiving higher-than-average EHR-generated inbox messages was strongly correlated with physician burnout.
“Notably, 45 percent of physicians with burnout symptoms received greater-than-average numbers of weekly system-generated in-basket messages, whereas 29 percent of physicians with burnout symptoms received only average or less-than-average numbers of the messages,” researchers stated.
Physicians with lower odds of experiencing burnout typically reported feeling that physicians are highly valued in the workplace, having control over one’s work schedule, and having a calm or busy (but reasonable) work environment.
“Those factors were also associated with lower odds of intending to reduce clinical work hours and having higher life satisfaction,” the team wrote.
“In contrast, high system-generated in-basket message volume; family medicine, internal medicine, and nonsurgical procedural specialties (compared to pediatricians) were associated with higher odds of intending to reduce clinical work hours,” researchers continued.
Researchers recommended that healthcare organizations and EHR developers reconsider their approach to improving care quality and population health by reducing the volume of EHR-generated messages.
“It may be time to examine whether every reminder to order routine chronic disease management lab tests (for example, periodic glycosylated hemoglobin A1c tests) must be signed and placed by a physician,” they suggested.
Improving EHR usability and cutting down on the amount of time providers are required to spend on desktop medicine has been a top priority in the healthcare industry for a few years.
Incorporating medical scribes into office visits, simplifying federal regulations related to clinical documentation, and specializing clinical workflows may help to reduce physician burnout associated with EHR use.
