Mayo Clinic study links EHR usability with clinician burnout

Researchers sought to assess and benchmark how physicians view electronic health record usability, as defined by a standardized metric, and use that to evaluate how poor UX correlates with feelings of job frustration and burnout.
By Mike Miliard
09:20 AM

Here's a sentence that does not mince words: "The usability of current EHR systems received a grade of F by physician users when evaluated using a standardized metric of technology usability. A strong dose-response relationship between EHR usability and the odds of burnout was observed."

WHY IT MATTERS
That's the conclusion of a new study published in Mayo Clinic Proceedings, which sought to assess and benchmark how physicians view electronic health record usability, as defined by a standardized metric, and use that to evaluate how poor usability correlates with feelings of burnout.

Researchers polled U.S. physicians across all specialties in 2017 and 2018, using the American Medical Association Physician Masterfile. Nearly 5,200 completed the surveys, with a random one-quarter of those respondents also asked to take a subsurvey evaluating their EHR thoughts on usability; 870 completed that second survey.

The physicians' assessments of EHR usability were scored using the System Usability Scale, a 1-100 rating, which was then "normalized to percentile rankings across more than 1300 previous studies from other industries." Burnout, meanwhile, was tracked using the Maslach Burnout Inventory.

The results? Mean SUS score was 45.9 – good for the bottom 9% when viewed in the context of  other UX studies in other industries. Researchers categorized that as "not acceptable," assigning a letter grade of F.

With "multivariate analysis adjusting for age, sex, medical specialty, practice setting, hours worked, and number of nights on call weekly, physician-rated EHR usability was independently associated with the odds of burnout with each 1 point more favorable SUS score associated with a 3% lower odds of burnout," according to the Mayo Clinic study.

THE LARGER TREND
Clearly, EHRs, many of them designed with federal meaningful use mandates and the billing imperatives top-of-mind, are still not serving physicians or their patients.

But they're only part – albeit a big one – of the clinician burnout epidemic. As a panel of experts explained earlier this year at Health 2.0, while many folks single out suboptimal EHR experience as as root cause, "burnout is multifactorial," said Dr. Michael Pfeffer, chief information officer at UCLA Health.

On top of poor EHR usability, physicians cite administrative burdens such as prior authorization, regulatory headaches, documentation requirements, malpractice concerns and the rise of consumerism. (Pfeffer says he hears often from physicians dismayed by poor online reviews from patients that they're powerless to fix.)

Ultimately, burnout is about "loss of control," said HIMSS Chief Clinical Officer, Dr. Charles Alessi. The EHR may have become the "epithet to hang everything on," he said, but this deep dissatisfaction among so many clinicians has a wide array of contributing factors.

Another recent study examined the work of radiologists, who may have less face time with EHRs than other specialties might, but still found "alarming" levels of stress and burnout – attributed generally to inefficient technologies and ever-increasing workloads.

ON THE RECORD
The Mayo Clinic study was conducted with help from with the American Medical Association, and AMA officials released a statement Thursday noting that Mayo's findings "will not come as a surprise to anyone who practices medicine. Too many physicians have experienced the demoralizing effects of cumbersome EHRs that interfere with providing first-rate medical care to patients.

"It is a national imperative to overhaul the design and use of EHRs and reframe the technology to focus primarily on its most critical function – helping physicians care for their patients," they added. "Significantly enhancing EHR usability is key and the AMA is working to ensure a new generation of EHRs are designed to prioritize time with patients, rather than overload physicians with type-and-click tasks."

Twitter: @MikeMiliardHITN
Email the writer: mike.miliard@himssmedia.com

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