Sa091 AFTER-HOURS ELECTRONIC HEALTH RECORD WORK DEMANDS FOR GASTROENTEROLOGY AND HEPATOLOGY PROVIDERS

Abstract Background As electronic health record (EHR) use becomes more widespread, detailed records of how users interact with the EHR, known as EHR audit logs, are being used to characterize the clinical workflows of physicians including residents. After-hours EHR use is of particular interest given its known association with physician burnout. Several studies have analyzed EHR audit logs for residents in other fields, such as internal medicine, but none thus far in ophthalmology. Here, we focused specifically on EHR use during on-call shifts outside of normal clinic hours. Methods In this retrospective study, we analyzed raw EHR audit log data from on-call shifts for 12 ophthalmology residents at a single institution over the course of a calendar year. Data were analyzed to characterize total time spent using the EHR, clinical volume, diagnoses of patients seen on call, and EHR tasks. Results Across all call shifts, the median and interquartile range (IQR) of the time spent logged into the EHR per shift were 88 and 131 minutes, respectively. The median (IQR) unique patient charts accessed per shift was 7 (9) patients. When standardized to per-hour measures, weekday evening shifts were the busiest call shifts with regard to both EHR use time and clinical volume. Total EHR use time and clinical volume were greatest in the summer months (July to September). Chart review comprised a majority (63.4%) of ophthalmology residents' on-call EHR activities. Conclusion In summary, EHR audit logs demonstrate substantial call burden for ophthalmology residents outside of regular clinic hours. These data and future studies can be used to further characterize the clinical exposure and call burden of ophthalmology residents and could potentially have broader implications in the fields of physician burnout and education policy.

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Reducing electronic health record-related burnout in providers through a personalized efficiency improvement program

Journal of the American Medical Informatics Association ◽

10.1093/jamia/ocaa248 ◽

2020 ◽

Author(s):

Eli M Lourie ◽

Levon Haig Utidjian ◽

Maria F Ricci ◽

Linda Webster ◽

Carola Young ◽

...

Keyword(s):

Electronic Health Record ◽

Health Record ◽

Efficiency Improvement ◽

Improvement Program ◽

Improve Efficiency ◽

After Hours ◽

The Mean ◽

Net Promoter ◽

Electronic Health ◽

The One

Abstract Objective To give providers a better understanding of how to use the electronic health record (EHR), improve efficiency, and reduce burnout. Materials and Methods All ambulatory providers were offered at least 1 one-on-one session with an “optimizer” focusing on filling gaps in EHR knowledge and lack of customization. Success was measured using pre- and post-surveys that consisted of validated tools and homegrown questions. Only participants who returned both surveys were included in our calculations. Results Out of 1155 eligible providers, 1010 participated in optimization sessions. Pre-survey return rate was 90% (1034/1155) and post-survey was 54% (541/1010). 451 participants completed both surveys. After completing their optimization sessions, respondents reported a 26% improvement in mean knowledge of EHR functionality (P < .01), a 19% increase in the mean efficiency in the EHR (P < .01), and a 17% decrease in mean after-hours EHR usage (P < .01). Of the 401 providers asked to rate their burnout, 32% reported feelings of burnout in the pre-survey compared to 23% in the post-survey (P < .01). Providers were also likely to recommend colleagues participate in the program, with a Net Promoter Score of 41. Discussion It is possible to improve provider efficiency and feelings of burnout with a personalized optimization program. We ascribe these improvements to the one-on-one nature of our program which provides both training as well as addressing the feeling of isolation many providers feel after implementation. Conclusion It is possible to reduce burnout in ambulatory providers with personalized retraining designed to improve efficiency and knowledge of the EHR.

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Promoting Quality Face-to-Face Communication during Ophthalmology Encounters in the Electronic Health Record Era

Applied Clinical Informatics ◽

10.1055/s-0040-1701255 ◽

2020 ◽

Vol 11 (01) ◽

pp. 130-141

Author(s):

Sally L. Baxter ◽

Helena E. Gali ◽

Michael F. Chiang ◽

Michelle R. Hribar ◽

Lucila Ohno-Machado ◽

...

Keyword(s):

Electronic Health Record ◽

High Volume ◽

Health Record ◽

Patient Centeredness ◽

Face To Face ◽

Single Sign On ◽

Timing Data ◽

After Hours ◽

Electronic Health ◽

Physician Patient

Abstract Objective To evaluate informatics-enabled quality improvement (QI) strategies for promoting time spent on face-to-face communication between ophthalmologists and patients. Methods This prospective study involved deploying QI strategies during implementation of an enterprise-wide vendor electronic health record (EHR) in an outpatient academic ophthalmology department. Strategies included developing single sign-on capabilities, activating mobile- and tablet-based applications, EHR personalization training, creating novel workflows for team-based orders, and promoting problem-based charting to reduce documentation burden. Timing data were collected during 648 outpatient encounters. Outcomes included total time spent by the attending ophthalmologist on the patient, time spent on documentation, time spent on examination, and time spent talking with the patient. Metrics related to documentation efficiency, use of personalization features, use of team-based orders, and note length were also measured from the EHR efficiency portal and compared with averages for ophthalmologists nationwide using the same EHR. Results Time spent on exclusive face-to-face communication with patients initially decreased with EHR implementation (2.9 to 2.3 minutes, p = 0.005) but returned to the paper baseline by 6 months (2.8 minutes, p = 0.99). Observed participants outperformed national averages of ophthalmologists using the same vendor system on documentation time per appointment, number of customized note templates, number of customized order lists, utilization of team-based orders, note length, and time spent after-hours on EHR use. Conclusion Informatics-enabled QI interventions can promote patient-centeredness and face-to-face communication in high-volume outpatient ophthalmology encounters. By employing an array of interventions, time spent exclusively talking with the patient returned to levels equivalent to paper charts by 6 months after EHR implementation. This was achieved without requiring EHR redesign, use of scribes, or excessive after-hours work. Documentation efficiency can be achieved using interventions promoting personalization and team-based workflows. Given their efficacy in preserving face-to-face physician–patient interactions, these strategies may help alleviate risk of physician burnout.

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Resident Duty Hours in the Outpatient Electronic Health Record Era: Inaccuracies and Implications

Journal of Graduate Medical Education ◽

10.4300/jgme-d-13-00061.1 ◽

2014 ◽

Vol 6 (1) ◽

pp. 151-154 ◽

Cited By ~ 11

Author(s):

Meghan Gilleland ◽

Katherine Komis ◽

Sonya Chawla ◽

Stephen Fernandez ◽

Mary Fishman ◽

...

Keyword(s):

Internal Medicine ◽

Electronic Health Record ◽

Health Record ◽

Duty Hours ◽

General Internal ◽

Resident Burnout ◽

After Hours ◽

Resident Duty ◽

Electronic Health ◽

Internal Medicine Clinic

Abstract Background The Accreditation Council for Graduate Medical Education expects resident duty hours to be monitored, yet no previous studies have examined the effect of after-hours electronic health record (EHR) use on resident hours or burnout. Objective We assessed internal medicine residents' perceived and actual time spent on after-hours outpatient EHR use and calculated increased duty hours if after-hours EHR use were included; we also assessed its effect on resident burnout. Methods We retrospectively aggregated time spent logged on to the outpatient EHR for residents in a general internal medicine clinic for 13 weeks in 2011. Residents completed a survey on EHR use, which was correlated with objectively recorded data on EHR usage. We compared actual and self-reported EHR time and identified violations that would be generated if these hours were included in reported duty hours. We also correlated resident after-hours EHR use with responses to an internally developed burnout survey. Results The 44 residents in this study overestimated time spent on the ambulatory EHR (they spent 3.03 hours/week on after-hours use compared with a recorded 1.20 hours/week). In total, 190 duty hour violations (mean duration of violation = 37 minutes) would have been generated if after-hours EHR usage were included in residents' reported duty hours. Conclusions Resident estimates of EHR use by residents were not accurate; including after-hours EHR use would increase the number of reported duty hour violations. There was no association between after-hours EHR use and resident burnout.

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Electronic health records and burnout: Time spent on the electronic health record after hours and message volume associated with exhaustion but not with cynicism among primary care clinicians

Journal of the American Medical Informatics Association ◽

10.1093/jamia/ocz220 ◽

2020 ◽

Vol 27 (4) ◽

pp. 531-538 ◽

Cited By ~ 16

Author(s):

Julia Adler-Milstein ◽

Wendi Zhao ◽

Rachel Willard-Grace ◽

Margae Knox ◽

Kevin Grumbach

Keyword(s):

Primary Care ◽

Electronic Health Record ◽

Academic Medical Center ◽

Maslach Burnout Inventory ◽

Health Record ◽

Full Time ◽

Full Time Equivalent ◽

After Hours ◽

Electronic Health ◽

High Exhaustion

Abstract Objectives The study sought to determine whether objective measures of electronic health record (EHR) use—related to time, volume of work, and proficiency—are associated with either or both components of clinician burnout: exhaustion and cynicism. Materials and Methods We combined Maslach Burnout Inventory survey measures (94% response rate; 122 of 130 clinicians) with objective, vendor-defined EHR use measures from log files (time after hours on clinic days; time on nonclinic days; message volume; composite measures of efficiency and proficiency). Data were collected in early 2018 from all primary care clinics of a large, urban, academic medical center. Multivariate regression models measured the association between each burnout component and each EHR use measure. Results One-third (34%) of clinicians had high cynicism and 51% had high emotional exhaustion. Clinicians in the top 2 quartiles of EHR time after hours on scheduled clinic days (those above the sample median of 68 minutes per clinical full-time equivalent per week) had 4.78 (95% confidence interval [CI], 1.1-20.1; P = .04) and 12.52 (95% CI, 2.6-61; P = .002) greater odds of high exhaustion. Clinicians in the top quartile of message volume (>307 messages per clinical full-time equivalent per week) had 6.17 greater odds of high exhaustion (95% CI, 1.1-41; P = .04). No measures were associated with high cynicism. Discussion EHRs have been cited as a contributor to clinician burnout, and self-reported data suggest a relationship between EHR use and burnout. As organizations increasingly rely on objective, vendor-defined EHR measures to design and evaluate interventions to reduce burnout, our findings point to the measures that should be targeted. Conclusions Two specific EHR use measures were associated with exhaustion.

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Electronic Health Record Effects on Work-Life Balance and Burnout Within the I3 Population Collaborative

Journal of Graduate Medical Education ◽

10.4300/jgme-d-16-00123.1 ◽

2017 ◽

Vol 9 (4) ◽

pp. 479-484 ◽

Cited By ~ 27

Author(s):

Sandy L. Robertson ◽

Mark D. Robinson ◽

Alfred Reid

Keyword(s):

Primary Care ◽

Electronic Health Record ◽

Work Life ◽

Work Life Balance ◽

Health Record ◽

Life Balance ◽

Practice Size ◽

After Hours ◽

Electronic Health ◽

The Relationship

ABSTRACT Background Physician burnout is a problem that often is attributed to the use of the electronic health record (EHR). Objective To estimate the prevalence of burnout and work-life balance satisfaction in primary care residents and teaching physicians, and to examine the relationship between these outcomes, EHR use, and other practice and individual factors. Methods Residents and faculty in 19 primary care programs were anonymously surveyed about burnout, work-life balance satisfaction, and EHR use. Additional items included practice size, specialty, EHR characteristics, and demographics. A logistic regression model identified independent factors associated with burnout and work-life balance satisfaction. Results In total, 585 of 866 surveys (68%) were completed, and 216 (37%) respondents indicated 1 or more symptoms of burnout, with 162 (75%) attributing burnout to the EHR. A total of 310 of 585 (53%) reported dissatisfaction with work-life balance, and 497 (85%) indicated that use of the EHR affected their work-life balance. Respondents who spent more than 6 hours weekly after hours in EHR work were 2.9 times (95% confidence interval [CI] 1.9–4.4) more likely to report burnout and 3.9 times (95% CI 1.9–8.2) more likely to attribute burnout to the EHR. They were 0.33 times (95% CI 0.22–0.49) as likely to report work-life balance satisfaction, and 3.7 times (95% CI 2.1–6.7) more likely to attribute their work-life balance satisfaction to the EHR. Conclusions More after-hours time spent on the EHR was associated with burnout and less work-life satisfaction in primary care residents and faculty.

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Physician Burnout and Timing of Electronic Health Record Use

ACI Open ◽

10.1055/s-0039-3401815 ◽

2020 ◽

Vol 04 (01) ◽

pp. e1-e8 ◽

Cited By ~ 3

Author(s):

Mark A. Micek ◽

Brian Arndt ◽

Wen-Jan Tuan ◽

Elizabeth Trowbridge ◽

Shannon M. Dean ◽

...

Keyword(s):

Internal Medicine ◽

Primary Care ◽

Electronic Health Record ◽

Work Hours ◽

Care Practice ◽

Health Record ◽

Physician Burnout ◽

After Hours ◽

Electronic Health ◽

The Relationship

Abstract Background Rates of burnout among physicians have been high in recent years. The electronic health record (EHR) is implicated as a major cause of burnout. Objective This article aimed to determine the association between physician burnout and timing of EHR use in an academic internal medicine primary care practice. Methods We conducted an observational cohort study using cross-sectional and retrospective data. Participants included primary care physicians in an academic outpatient general internal medicine practice. Burnout was measured with a single-item question via self-reported survey. EHR time was measured using retrospective automated data routinely captured within the institution's EHR. EHR time was separated into four categories: weekday work-hours in-clinic time, weekday work-hours out-of-clinic time, weekday afterhours time, and weekend/holiday after-hours time. Ordinal regression was used to determine the relationship between burnout and EHR time categories. Results EHR use during in-clinic sessions was related to burnout in both bivariate (odds ratio [OR] = 1.04, 95% confidence interval [CI]: 1.01, 1.06; p = 0.007) and adjusted (OR = 1.07, 95% CI: 1.03, 1.1; p = 0.001) analyses. No significant relationships were found between burnout and after-hours EHR use. Conclusion In this small single-institution study, physician burnout was associated with higher levels of in-clinic EHR use but not after-hours EHR use. Improved understanding of the variability of in-clinic EHR use, and the EHR tasks that are particularly burdensome to physicians, could help lead to interventions that better integrate EHR demands with clinical care and potentially reduce burnout. Further studies including more participants from diverse clinical settings are needed to further understand the relationship between burnout and after-hours EHR use.

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EHR Overtime: An Analysis of Time Spent After Hours by Family Physicians

Family Medicine ◽

10.22454/fammed.2020.942762 ◽

2020 ◽

Vol 52 (2) ◽

pp. 135-137 ◽

Cited By ~ 2

Author(s):

Jacob Anderson ◽

Jason Leubner ◽

Steven R. Brown

Keyword(s):

Family Medicine ◽

Electronic Health Record ◽

Tracking System ◽

Family Physicians ◽

Well Being ◽

Direct Patient Care ◽

Health Record ◽

After Hours ◽

Electronic Health ◽

Family Medicine Residents

Background and Objectives: Time spent in the electronic health record (EHR), away from direct patient care, is associated with physician burnout. Yet there is a lack of evidence quantifying EHR use among family physicians. The purpose of the study was to describe a method for quantifying habits and duration of use within the electronic health record in family medicine residents and faculty with particular attention paid to time spent after hours. Methods: We audited EHR time for family medicine residents and faculty using an EHR vendor-provided, web-based tracking system. We collected and analyzed the number of patient encounters, total time in the EHR per patient, total time in the EHR after hours by physicians for a 6-month time period. Results: Over the 6-month period reviewed, family medicine trainees and faculty saw between one and 164 patients monthly, spent between 17 and 217 minutes in the EHR per patient, and spent between 0 and 33 hours in the EHR after hours per month. Conclusions: Family medicine residents spend a significant amount of time completing EHR tasks after hours. Objective EHR data can be used by family medicine residency programs to devise interventions to decrease inefficient use of the EHR, decrease after-hours EHR use, and improve well-being.

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