In-basket messages sent from the EHR may drive physician burnout, study finds

Increasing amounts of in-basket messages generated by the EHR is correlated to higher levels of burnout symptoms among physicians, according to a study published in Health Affairs.

For the study, Palo Alto (Calif.) Medical Foundation researchers analyzed EHR workflows and survey results from 934 primary and specialty care physicians from the nonprofit organization during a six-week period in 2016. The team observed the volume of in-basket messages in the physicians' workflows as well as the physicians' responses to a burnout measure survey.

Of the multispecialty practice physicians, the researchers found that in-basket messages generated by the EHR totaled 114, which is almost half of the 243 weekly in-basket messages received by each physician on average. These messages included pending orders, prior authorization requests and patient health reminders. Additionally, 42 percent of physicians received more than the average number of EHR messages per week.

Survey results showed that 36 percent of physicians reported experiencing burnout symptoms, and 29 percent of participants said they wanted to decrease their clinical work time in the coming year. Physicians who received more than 114 EHR-generated in-basket messages were associated with a 40 percent increase in probability for burnout and 38 percent higher probability of intention to decrease clinical work time.

The study authors noted that the research presented various limitations, including the use of only one questionnaire on burnout and its neglect to measure other related aspects of well being besides burnout symptoms, intention to reduce clinical work time and physicians' life satisfaction. Additionally, the survey's question wording was only vetted by Palo Alto Medical Foundation physicians and leaders, the study did not analyze the amount of in-basket messages that had been read or responded to and the results of the research came from analyzing one large healthcare organization that adopted an EHR in 1999, so the results may not be generalizable.

The study authors concluded that healthcare organizations should consider different approaches to alleviate physician burnout by redesigning EHR in-basket workflows, such as re-routing certain messages to nonphysician clinicians and instituting new email work policies.

To access the full report, click here.

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