The Relationship Between EMRs and Physician Stress

The adoption of electronic medical records is at an all-time high, with 409,839 eligible professionals and providers receiving federal incentive payments for the adoption or use of EMR systems, according to the most recent data from CMS.

A recent study published in the Journal of the American Medical Informatics Association examines the effect of the now near-omnipresent EMRs and working conditions on stress, satisfaction and burnout among primary care physicians.

The study analyzed survey results from 379 physicians working in 92 clinics across New York, Chicago, Milwaukee, Madison, Wis., and in several rural areas in Wisconsin. Physicians reported time pressure felt during patient encounters, as well as perceived control over workplace issues, job satisfaction and job burnout. Clinic managers also completed a survey about EMR use in the practice and how many of 15 common features or functionalities as identified by researchers were available through the clinic's EMR.

Based off the survey given to the clinic managers, three groups of clinics were defined based on the number of EMR features present: those reported as having the majority of the 15 most common features, those with a moderate amount and those with a low number of the most common features. High-function EMRs were found in 50 percent of the total sample, moderate-function EMRs were found in 24 percent and low-function EMRs were found in 26 percent.

Researchers then compared the physicians' responses with the classification of their clinic’s EMR functions (high, medium or low). Compared with physicians at clinics with low-function EMRs, physicians at clinics with moderate-function EMRs experienced significantly more stress and had a higher rate of burnout. Additionally, physicians at clinics with moderate- or high-function EMRs felt less satisfied with their current position overall.

To lead researcher Stewart Babbott, MD, of the University of Kansas Medical Center in Kansas City, the poor physician outcomes at clinics with moderate-function EMRs suggest these clinics were in a time of transition, and the limited functionality interrupted a physician's workflow. "Our finding that physician-reported stress was highest in the moderate-use group 'made sense' for those practices in which some of the functions were on paper and some in the electronic record or for those without a fully functioning EMR," he says.

Results also showed a significant relationship between time pressure and physician stress in the cohort with high-function EMRs, and only in this cohort, suggesting physicians at these clinics may be particularly pressured for time during patient encounters in the face of a large number of EMR functions. "This 'made sense' to us in thinking about the possibility that those in the high-use group had more to do in the EMR," says Dr. Babbott.

Dr. Babbott stresses, however, that the study shows correlation, not causality, and further studies are needed to determine exact relationships.

"Further study is needed to focus on those efforts which can be most specifically related to EMR use," he says. "If the moderate-use group's higher stress is due to that practice being in transition between a paper-based system and an EMR, then this work supports stress being an issue to address during that transition. Similarly, if the high-use group's stress is related to more functions and requirements for each patient's care, then addressing processes of care and care team support could be of benefit."

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