ĮHRs are often designed to send alerts and messages about patient care tasks directly to the physician, regardless of the skill set needed to process the tasks (e.g., medication refill requests, reminders to schedule cancer screenings, or obtaining test results). This phenomenon is so ubiquitous that it is known as “death by a thousand clicks”. Many EHRs require an excessive number of steps, or clicks, to carry out a simple function, such as reviewing a patient’s allergies or renewing prescriptions. physicians’ notes are four times as long as their counterparts in other countries. A focus on ensuring data elements for billing purposes are entered into the EHR has led to “note bloat,” or excessively long notes. Indirectly, the EHR may disrupt the patient-clinician relationship and increase inefficiencies, cognitive load, and the risk of clinician burnout. Clinicians spend one-half to two-thirds of each workday on EHR and desk work instead of on direct patient care. Furthermore, archaic paper-based workflows were commonly transferred into electronic form instead of creating more streamlined, technology-enabled workflows. While EHRs have offered many benefits, EHR design currently emphasizes billing and administrative functions over care delivery and clinical decision making. Problem Overview: Electronic Health Records and Clinician Well-Being
This paper provides strategies to help health care organizations embark on their EHR optimization journey toward improved patient care and clinician well-being. Optimization requires a tailored, multipronged strategy that incorporates an organization’s clinician-identified pain points, clinical informatics and technology resources, and clinician and leadership buy-in. To shift the pendulum from clinician burnout to well-being, it is imperative that health care organizations take action to optimize the EHR.ĮHR optimization relies on human factors engineering, a science that considers the benefits and fallibility of human interaction with a system.
In February 2020, the Office of the National Coordinator for Health Information Technology published a strategy on reducing EHR-related burden, further signaling the urgency for health care leaders to optimize the EHR. Clinician burnout (a syndrome characterized by emotional exhaustion, depersonalization, and a low sense of personal accomplishment) is associated with higher rates of medical errors, health care costs, and clinician turnover. While intended to improve care quality and efficiency, the EHR has inadvertently burdened clinicians and is now considered a leading cause of their burnout. In the United States, 86 percent of office-based and 94 percent of hospital-based physicians currently use an electronic health record (EHR), incentivized by the 2009 Health Information Technology for Economic and Clinical Health Act.