A recent study from Stanford University highlights the scale of this challenge in the United States.  It found that the clinical notes of American doctors were roughly four times as long as their peers in other countries.

This in turn appears to have a knock-on effect on the enthusiasm of American doctors for the digitization of medical notes.  The researchers noticed a clear divide in enthusiasm between doctors in America and doctors in countries like Australia and Singapore for electronic medical records.

This unintended consequence of the digitization of patient records was reiterated in a second paper from researchers at Brown University, which was published recently.  The paper found that the roll out of electronic medical records has increased stress and burnout among doctors.

“You don’t want your doctor to be burned out or frustrated by the technology that stands between you and them,” the researchers explain. “In this paper, we show that EHR stress is associated with burnout, even after controlling for a lot of different demographic and practice characteristics. Quantitatively, physicians who have identified these stressors are more likely to be burned out than physicians who haven’t.”

Stressed out

The researchers utilized the Rhode Island Department of Health surveys, which are surveys sent out every two years to gauge how physicians are using technology.  The 2017 edition also included questions on stress, and specifically EHR-related stress.

Of those who responded, 91% were using EHRs, with a whopping 70% of them reporting at least one measure of EHR-related stress, including frustration about how the technology worked, and taking EHR-related work home with them.

Time was a common concern, with doctors who felt they had insufficient time to do their documentation at work suffering burnout at 2.8 times the rate of their peers who didn’t suffer in the same way.  This lack of time was far and away the most serious cause of burnout found by the data.

There also seemed to be some correlation with the speciality of the physician, with around 1 in 3 of primary care physicians revealing that they suffered from all three of the EHR-related stress measures.  This falls to below 10% for radiologists, which underlines the fact that this isn’t going to be fixed by a one-size-fits-all solution.

“To me, it’s a signal to health care organizations that if they’re going to ‘fix’ burnout, one solution is not going to work for all physicians in their organization,” the authors explain. “They need to look at the physicians by specialty and make sure that if they are looking for a technology-related solution, then that’s really the problem in their group.”

Reducing the strain

Nonetheless, the authors do believe that a good start for those doctors who are suffering a lot of EHR-related stress is to try and streamline the documentation processes and expectations, whilst also discouraging access to EHRs at home or on vacation.

Work could also be put into improving the user interface to make them easier to use, whilst some healthcare providers have even taken to using medical scribes to take the burden off entirely.  The authors believe this new role might address the burden of documentation, but not the various other time-consuming aspects of EHR-related work, such as managing one’s inbox.

It would be interesting to understand what the 60% of so of doctors who weren’t suffering from EHR-related burnout were doing differently, and if there are any lessons from their experience that could be applied more widely.

They’re also aware however, that as the survey is not anonymous, it’s quite probable that burnout levels were under-reported, so the problem might be a lot bigger than the results suggest.  Burnout in healthcare is a pressing issue at the best of times, but it seems madness that technology that’s designed to help actually makes stress worse.  The sooner this is fixed, the better.