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Analysis

Physician Fatigue Linked to Electronic Health Record Use

By Christopher Cheney  
   July 20, 2020

New research provides more evidence that electronic health record use contributes to physician burnout.

Most physicians experience fatigue working with electronic health records (EHRs) for as little as 22 minutes, a recent research article indicates.

EHR use has been directly linked to physician burnout. For years, physicians have complained about click-intense and data-busy EHR interfaces. Excessive EHR screen time has been associated with medical errors.

The recent research article, which was published by JAMA Network Open, features data collected from 25 physicians who completed four simulated reviews of ICU patients using the Epic EHR.

"Physicians experience electronic health record-related fatigue in short periods of continuous electronic health record use, which may be associated with inefficient and suboptimal electronic health record use. … The use of electronic health records is directly associated with physician burnout. An underlying factor associated with burnout may be EHR-related fatigue owing to insufficient user-centered interface design and suboptimal usability," the researchers wrote.

The research article features several key data points:

  • Every physician in the study experienced physiological fatigue at some point in reviewing the four simulated ICU cases with the EHR
     
  • 36% of the physicians experienced fatigue in the first minute of the study
     
  • 64% of the physicians experienced fatigue at least once in the first 20 minutes of the study
     
  • 80% of the physicians experienced fatigue after 22 minutes of the study
     
  • If a physician experienced fatigue while reviewing one simulated ICU case, the next case took more time, more mouse clicks, and more EHR screen visits to finish

The study's findings probably underestimate the level of fatigue physicians experience when using an EHR, the researchers wrote. "When compared with a typical day in an ICU, the simulation undertested the clinical demands of a physician. First-year trainees routinely review five or more patients, while upper-level residents, fellows, and attending physicians routinely review 12 or more patients."

Research implications

Continuous EHR use negatively affects physician efficiency and performance, which can compromise patient safety, the lead author of the research article told HealthLeaders.

"Once fatigued, physicians spend more time and effort completing tasks for the next patient. Consequently, fatigued physicians may be at a higher risk of missing key patient information that is needed to make accurate assessments and care plans. Therefore, the 'carry-over' effect of EHR-related fatigue is directly associated with patient safety risks," said Saif Khairat, PhD, MPH, an assistant professor at University of North Carolina at Chapel Hill.

The research also has implications for physician burnout, he said.

"It takes only 22 minutes for 80% of physicians to experience fatigue. In reality, physicians spend hours working in the EHR; and therefore, it is evident that physicians experience recurring instances of fatigue while using the EHR. The long-term effect of constant and recurring EHR-related fatigue leads to physician burnout."

Christopher Cheney is the senior clinical care​ editor at HealthLeaders.


KEY TAKEAWAYS

Many physicians have expressed dissatisfaction with click-intense and data-busy electronic health record interfaces.

Recent research examined physician fatigue while clinicians reviewed four simulated ICU cases in the Epic electronic health record.

After conducting the simulated case reviews for 22 minutes, 80% of the participating physicians experienced fatigue.


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