Shifting from a paper to an electronic practice may actually make doctors less happy and more burnt out
While it is supposed to improve healthcare for both doctors and patients, shifting from a paper to an electronic practice may actually make doctors less happy and more burnt out, a new study suggests.
In particular, use of electronic health records and computerised physician order entry were the two factors linked to the most professional dissatisfaction and the highest rates of burnout, Mayo Clinic researchers have found.
“Although electronic health records, electronic prescribing and computerised physician order entry have been touted as ways to improve quality of care, these tools also create clerical burden, cognitive burden, frequent interruptions and distraction – all of which can contribute to physician burnout,” said lead author Dr Tait Shanafelt, a Mayo Clinic physician.
“Burnout has been shown to erode quality of care, increase risk of medical errors, and lead physicians to reduce clinical work hours, suggesting that the net effect of these electronic tools on quality of care for the US health care system is less clear,” the authors wrote.
Their survey on a national sample of 6560 doctors from the American Medical Association database used a validated questionnaire to assess burnout, and is one of number of studies published by the researchers on physician welfare.
Out of all the specialties, GPs were the least happy with the amount of time they spent on tasks unrelated to patient care, barring urologists.
And behind urologists, family medicine doctors were the most burnt-out of the group.
Professional burnout normally manifested as emotional exhaustion, loss of meaning in work, and feelings of ineffectiveness, the authors said.
The underlying problem was the ways doctors were supposed to record information did not align very well with the existing clinical workflow, Dr Nathan Pinskier, chair of the RACGP’s Expert Committee eHealth and Practice Systems.
“The reality is that what we’ve done so far in terms of electronic health records is essentially just converting pen and paper records into an electronic form,” he said.
“We haven’t done anything more sophisticated, and yet we’ve upped the ante in terms of demanding clinicians to become clerks. They’re now required to add more information to more and more documents.”
On top of that, doctors were working in an environment that was more highly regulated and with more compliance demands than they were 50 years ago, Dr Pinskier said.
These were likely to be contributing factors to increasing fatigue and less job satisfaction, he said.
Chair of the Victorian Doctors Health Program, psychiatrist Dr Bill Pring, said there was a need to include doctors in the planning of e-health systems.
“Few electronic health records have been robustly designed around doctors’ needs, or to enhance the doctor-patient interaction,” Dr Pring said. “They have been designed for managerial information utility or consumer satisfaction.”
“Yet it is just as much the doctors’ record, too.”
He pointed out that younger doctors reported less trouble with electronic health records than their older counterparts, suggesting the older clinicians had to go through a potentially frustrating adjustment period.
Professional dissatisfaction and burnout might be due to managerial disempowerment, combined with the implementation of e-health records, Dr Pring said.
“I note that doctors were burdened by all clerical duties to some extent, and clerical duties seem to have increased markedly over recent years.”
