Electronic health records and burnout: Time spent on the electronic health record after hours and message volume associated with exhaustion but not with cynicism among primary care clinicians
Electronic health records and burnout: Time spent on the electronic health record after hours and message volume associated with exhaustion but not with cynicism among primary care clinicians
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DOI：
10.1093/jamia/ocz220
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发表时间：
2020-04-01
影响因子：
6.4
通讯作者：
Grumbach, Kevin
中科院分区：
文献类型：
--
作者：
Adler-Milstein, Julia;Zhao, Wendi;Grumbach, Kevin
目的：本研究试图确定电子健康记录（EHR）使用的客观测量（与时间、工作量和熟练度相关）是否与临床医生倦怠的一个或两个组成部分（疲惫和愤世嫉俗）相关。材料和方法：我们结合Maslach倦怠量表调查测量（94%的响应率; 130名临床医生中的122名），使用来自日志文件的客观、供应商定义的EHR使用措施（门诊日下班后的时间;非门诊日的时间;信息量;效率和熟练度的综合指标）。数据收集于2018年初，来自一个大型城市学术医疗中心的所有初级保健诊所。多变量回归模型测量了每个倦怠成分和每个EHR使用measure.Results之间的关联：三分之一（34%）的临床医生有高度的玩世不恭和51%有高度的情绪疲惫。在计划的门诊日，EHR小时后时间前2个四分位数的临床医生（高于每周每个临床全职等效时间68分钟的样本中位数）有4.78（95%置信区间[CI]，1.1-20.1; P = 0.04）和12.52（95% CI，2.6-61; P = 0.002）更高的高度疲惫几率。消息量最高的四分位数（每周每个临床全职当量>307条消息）的临床医生有6.17的高疲惫几率（95%CI，1.1-41; P = 0.04）。没有措施与高度cynicis.Discussion：EHR已被引用为临床医生倦怠的贡献者，自我报告的数据表明EHR的使用和倦怠之间的关系。随着组织越来越多地依赖于客观的，供应商定义的EHR措施来设计和评估干预措施，以减少倦怠，我们的研究结果指出，应该有针对性的措施。结论：两个具体的EHR使用措施与疲惫。
Objectives: The study sought to determine whether objective measures of electronic health record (EHR) use-related to time, volume of work, and proficiency-are associated with either or both components of clinician burnout: exhaustion and cynicism.Materials and Methods: We combined Maslach Burnout Inventory survey measures (94% response rate; 122 of 130 clinicians) with objective, vendor-defined EHR use measures from log files (time after hours on clinic days; time on nonclinic days; message volume; composite measures of efficiency and proficiency). Data were collected in early 2018 from all primary care clinics of a large, urban, academic medical center. Multivariate regression models measured the association between each burnout component and each EHR use measure.Results: One-third (34%) of clinicians had high cynicism and 51% had high emotional exhaustion. Clinicians in the top 2 quartiles of EHR time after hours on scheduled clinic days (those above the sample median of 68 minutes per clinical full-time equivalent per week) had 4.78 (95% confidence interval [CI], 1.1-20.1; P = .04) and 12.52 (95% CI, 2.6-61; P = .002) greater odds of high exhaustion. Clinicians in the top quartile of message volume (>307 messages per clinical full-time equivalent per week) had 6.17 greater odds of high exhaustion (95% CI, 1.1-41; P = .04). No measures were associated with high cynicism.Discussion: EHRs have been cited as a contributor to clinician burnout, and self-reported data suggest a relationship between EHR use and burnout. As organizations increasingly rely on objective, vendor-defined EHR measures to design and evaluate interventions to reduce burnout, our findings point to the measures that should be targeted.Conclusions: Two specific EHR use measures were associated with exhaustion.