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Appl Clin Inform 2017; 08(03): 686-697
DOI: 10.4338/ACI-2017-01-RA-0003
Research Article
Schattauer GmbH

Electronic Health Record Alert-Related Workload as a Predictor of Burnout in Primary Care Providers

Megan E. Gregory
1   Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, TX
2   Section of Health Services Research, Department of Medicine, Baylor College of Medicine, Houston, TX
,
Elise Russo
1   Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, TX
2   Section of Health Services Research, Department of Medicine, Baylor College of Medicine, Houston, TX
,
Hardeep Singh
1   Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, TX
2   Section of Health Services Research, Department of Medicine, Baylor College of Medicine, Houston, TX
› Institutsangaben Funding The research reported here was supported in part by the U.S. Department of Veterans Affairs, Veterans Health Administration, Health Services Research and Development Service, Office of Academic Affiliations, Health Professions Education Evaluation and Research Advanced Fellowship and in part by Center for Innovations in Quality, Effectiveness and Safety (CIN 13–413), Michael E. DeBakey VA Medical Center, Houston, TX.
Dr. Singh is additionally supported by the VA Health Services Research and Development Service (CRE 12–033; Presidential Early Career Award for Scientists and Engineers USA 14–274), the VA National Center for Patient Safety, and the Agency for Health Care Research and Quality (R01HS022087 and R21HS023602). The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the U.S. Department of Veterans Affairs or the United States government.
Weitere Informationen

Publikationsverlauf

received: 03. Januar 2017

accepted: 21. April 2017

Publikationsdatum:
20. Dezember 2017 (online)

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Summary

Background: Electronic health records (EHRs) have been shown to increase physician workload. One EHR feature that contributes to increased workload is asynchronous alerts (also known as inbox notifications) related to test results, referral responses, medication refill requests, and messages from physicians and other health care professionals. This alert-related workload results in negative cognitive outcomes, but its effect on affective outcomes, such as burnout, has been under-studied.

Objectives: To examine EHR alert-related workload (both objective and subjective) as a predictor of burnout in primary care providers (PCPs), in order to ultimately inform interventions aimed at reducing burnout due to alert workload.

Methods: A cross-sectional questionnaire and focus group of 16 PCPs at a large medical center in the southern United States.

Results: Subjective, but not objective, alert workload was related to two of the three dimensions of burnout, including physical fatigue (p = 0.02) and cognitive weariness (p = 0.04), when controlling for organizational tenure. To reduce alert workload and subsequent burnout, participants indicated a desire to have protected time for alert management, fewer unnecessary alerts, and improvements to the EHR system.

Conclusions: Burnout associated with alert workload may be in part due to subjective differences at an individual level, and not solely a function of the objective work environment. This suggests the need for both individual and organizational-level interventions to improve alert workload and subsequent burnout. Additional research should confirm these findings in larger, more representative samples.

Citation: Gregory ME, Russo E, Singh H. Electronic health record alert-related workload as a predictor of burnout in primary care providers. Appl Clin Inform 2017; 8: 686–697 https://doi.org/10.4338/ACI-2017-01-RA-0003

Keywords

Electronic health records - workload - burnout - health information technology - safety

Clinical Relevance Statement

While the knowledge on various components of workload and methods regarding how to measure these components is well-grounded [[23]–[25]], there is a dearth of studies that examine the impact of both objective and subjective workload on work outcomes. To our knowledge, this is one of the first to show that subjective, but not objective, workload leads to negative affective outcomes (i.e., burnout). This finding is important in guiding future research and in informing improvements in EHR design and processes to manage inbox alerts.


Human Subjects Protections

This study was approved by the Baylor College of Medicine Institutional Review Board and the local VA Research Office.


 

  • References

  • 1 Poissant L, Pereira J, Tamblyn R, Kawasumi Y. The impact of electronic health records on time efficiency of physicians and nurses: A systematic review. J Am Med Inform Assoc 2005; 12: 505-516.
    CrossrefPubMedGoogle Scholar
  • 2 Murphy DR, Reis B, Sittig DF, Singh H. Notifications received by primary care practitioners in electronic health records: A taxonomy and time analysis. Am J Med 2012; 125: 209-e1-e7.
    CrossrefPubMedGoogle Scholar
  • 3 Murphy DR, Meyer AN, Russo E, Sittig DF, Wei L, Singh H. The burden of inbox notifications in commercial electronic health records. JAMA Intern Med 2016; 176: 559-560.
    CrossrefPubMedGoogle Scholar
  • 4 Singh H, Spitzmueller C, Petersen NJ, Sawhney MK, Smith MW, Murphy DR, Espadas D, Laxmisan A, Sittig DF. Primary care practitioners’ views on test result management in EHR-enabled health systems: A national survey. J Am Med Inform Assoc 2012; 20: 727-735.
    CrossrefPubMedGoogle Scholar
  • 5 Singh H, Spitzmueller C, Petersen NJ, Sawhney MK, Sittig DF. (2013). Information overload and missed test results in electronic health record–based settings. JAMA Intern Med 2013; 173: 702-704.
    PubMedGoogle Scholar
  • 6 Hysong SJ, Sawhney MK, Wilson L, Sittig DF, Esquivel A, Singh S, Singh H. Understanding the management of electronic test result notifications in the outpatient setting. BMC Med Inform Decis Mak 2011; 11: 1-9.
    CrossrefPubMedGoogle Scholar
  • 7 Dunford BB, Shipp AJ, Boss RW, Angermeier I, Boss AD. Is burnout static or dynamic? A career transition perspective of employee burnout trajectories. J Appl Psychol 2012; 97: 637-650.
    CrossrefPubMedGoogle Scholar
  • 8 Toker S, Biron M. Job burnout and depression: Unraveling their temporal relationship and considering the role of physical activity. J Appl Psychol 2012; 97: 699-710.
    CrossrefPubMedGoogle Scholar
  • 9 Aiken LH, Clarke SP, Sloane DM, Sochalski J, Silber JH. Hospital nurse staffing and patient mortality, nurse burnout, and job dissatisfaction. JAMA 2002; 288: 1987-1993.
    CrossrefPubMedGoogle Scholar
  • 10 Cordes CL, Dougherty TW. A review and an integration of research on job burnout. Acad Manage Rev 1993; 18: 621-656.
    CrossrefPubMedGoogle Scholar
  • 11 Maslach C, Schaufeli WB, Leiter MP. Job burnout. Annu Rev Psychol 2001; 52: 397-422.
    CrossrefPubMedGoogle Scholar
  • 12 McManus IC, Keeling A, Paice E. Stress, burnout and doctors’ attitudes to work are determined by personality and learning style: A twelve year longitudinal study of UK medical graduates. BMC Med 2004; 2: 1-12.
    CrossrefPubMedGoogle Scholar
  • 13 Brill PL. The need for an operational definition of burnout. Fam Community Health 1984; 6: 12-24.
    CrossrefPubMedGoogle Scholar
  • 14 Cherniss C. Staff burnout. Beverly Hills, CA: Sage; 1980
    PubMedGoogle Scholar
  • 15 Hallsten L. Burning out: A framework. In: Schaufeli WB, Maslach C, Marek T. editors. Professional burn-out: Recent developments in theory and research. Philadelphia, PA:: Taylor & Francis; 1993. p. 95-113.
    Google Scholar
  • 16 Buchbinder SB, Wilson M, Melick CF, Powe NR. Estimates of costs of primary care physician turnover. Am J Manag Care 1999; 5: 1431-1438.
    PubMedGoogle Scholar
  • 17 Haas JS, Cook EF, Puopolo AL, Burstin HR, Cleary PD, Brennan TA. Is the professional satisfaction of general internists associated with patient satisfaction?. J Gen Intern Med 2000; 15: 122-128.
    CrossrefPubMedGoogle Scholar
  • 18 Hall LH, Johnson J, Watt I, Tsipa A, O’Connor DB. Healthcare staff wellbeing, burnout, and patient safety: A systematic review. PLoS One 2016; 11: e0159015.
    CrossrefPubMedGoogle Scholar
  • 19 Dyrbye LN, Thomas MR, Massie FS, Power DV, Eacker A, Harper W, Duming S, Moutier C, Szydlo DW, Novotny PJ, Sloan JA, Shanafelt TD. Burnout and suicidal ideation among US medical students. Ann Intern Med 2008; 149: 334-341.
    CrossrefPubMedGoogle Scholar
  • 20 Thomas NK. Resident burnout. JAMA 2004; 292: 2880-2889.
    CrossrefPubMedGoogle Scholar
  • 21 Shanafelt TD, Boone S, Tan L, Dyrbye LN, Sotile W, Satele D, West CP, Sloan J, Oreskovich MR. Burnout and satisfaction with work-life balance among US physicians relative to the general US population. Arch Intern Med 2012; 172: 1377-1385.
    CrossrefPubMedGoogle Scholar
  • 22 Mauthe AJ, Boudreau RA, Lalumiere ML. Physician burnout: A “meta-o-scopic” analysis. Poster presented at the 8th International Conference on Occupational Stress and Health; Puerto Rico 2009
    PubMedGoogle Scholar
  • 23 Van Emmerik IH, Jawahar IM. The independent relationships of objective and subjective workload with couples’ mood. Hum Relat 2006; 59: 1371-1392.
    CrossrefPubMedGoogle Scholar
  • 24 Hoonakker P, Carayon P, Gurses AP, Brown R, McGuire K, Khunlertkit A, Walker JM. (2011). Measuring workload of ICU nurses with a questionnaire survey: The NASA Task Load Index (TLX). IEE Trans Healthc Syst Eng 2011; 1: 131-143.
    PubMedGoogle Scholar
  • 25 Matthews G, Reinerman-Jones LE, Barber DJ, Abich J. The psychometrics of mental workload multiple measures are sensitive but divergent. Hum Factors 2015; 57: 125-143.
    CrossrefPubMedGoogle Scholar
  • 26 Shirom A. Burnout in work organizations. In: Cooper CL, Robertson I. editors. International review of industrial and organization psychology. Chichester, U.K.:: Wiley; 1989: 25-48.
    Google Scholar
  • 27 Shirom A. Job-related burnout: A review. In: Quick JC, Tetrick LE. editors. Handbook of occupational health psychology. Washington, DC:: American Psychological Association; 2003: 245-265.
    CrossrefGoogle Scholar
  • 28 Shirom A, Melamed S. A comparison of the construct validity of two burnout measures in two groups of professionals. Intl J Stress Manag 2006; 13: 176-200.
    CrossrefPubMedGoogle Scholar
  • 29 Schaufeli W, Le Blanc P. Personnel. In: Miranda DR, Ryan DW, Schaufeli WB, Fidler V. editors. Organisation and Management of Intensive Care: A Prospective Study in 12 European Countries. Berlin, Heidelberg:: Springer; 1998: 169-205.
    Google Scholar
  • 30 Demerouti E, Bakker AB, Nachreiner F, Schaufeli WB. The job demands-resources model of burnout. J Appl Psychol 2001; 86: 499-512.
    CrossrefPubMedGoogle Scholar
  • 31 Singh H, Wilson L, Reis B, Sawhney MK, Espadas D, Sittig DF. Ten strategies to improve management of abnormal test result alerts in the electronic health record. J Patient Saf 2010; 6: 121-123.
    CrossrefPubMedGoogle Scholar
  • 32 Shanafelt TD, Dyrbye LN, Sinsky C, Hasan O, Satele D, Sloan J, West CP. Relationship between clerical burden and characteristics of the electronic environment with physician burnout and professional satisfaction. Mayo Clin Proc 2016; 91: 836-848.
    CrossrefPubMedGoogle Scholar
  • 33 Sonnentag S, Frese M. Stress in organizations. In: Schmitt NW, Highhouse S. editors. Handbook of Psychology. 2nd ed. Vol 12. Hoboken, NJ:: John Wiley & Sons, Inc.; 2013: 560-592.
    Google Scholar
  • 34 Singh H. A checklist to improve CPRS ‘View Alert’ notifications: Recommendations for VA facility leadership and staff. Houston (TX):: Michael E. DeBakey VA Medical Center; 2016
    PubMedGoogle Scholar
  • 35 Lowry SZ, Ramaiah M, Patterson ES, Brick D, Gurses AP, Ozok A, Simmons D, Gibbons MC. Integrating electronic health records into clinical workflow: An application of human factors modeling methods to ambulatory care. Proceedings of the International Symposium on Human Factors and Ergonomics in Health Care 2014; 3: 170-177.
    CrossrefPubMedGoogle Scholar
  • 36 Foster B, Williams RB. Substitution of self-reporting for observing time spent on work activities by mental health professionals. Psychol Rep 1989; 64: 945-946.
    CrossrefPubMedGoogle Scholar
  • 37 Simon SR, Kaushal R, Cleary PD, Jenter CA, Volk LA, Poon EG, Orav J, Lo HG, Williams DH, Bates DW. Correlates of electronic health record adoption in office practices: A statewide survey. J Am Med Inform Assoc 2007; 14: 110-117.
    CrossrefPubMedGoogle Scholar