scholarly journals Are specific elements of electronic health record use associated with clinician burnout more than others?

2020 ◽  
Vol 27 (9) ◽  
pp. 1401-1410
Author(s):  
Ross W Hilliard ◽  
Jacqueline Haskell ◽  
Rebekah L Gardner
Keyword(s):  
Confidence Interval ◽  
Electronic Health Record ◽  
Odds Ratio ◽  
Adjusted Odds Ratio ◽  
Well Being ◽  
Health Record ◽  
Face To Face ◽  
Efficiency Measures ◽  
Electronic Health ◽  
Copy And Paste

Abstract Objective The study sought to examine the association between clinician burnout and measures of electronic health record (EHR) workload and efficiency, using vendor-derived EHR action log data. Materials and Methods We combined data from a statewide clinician survey on burnout with Epic EHR data from the ambulatory sites of 2 large health systems; the combined dataset included 422 clinicians. We examined whether specific EHR workload and efficiency measures were independently associated with burnout symptoms, using multivariable logistic regression and controlling for clinician characteristics. Results Clinicians with the highest volume of patient call messages had almost 4 times the odds of burnout compared with clinicians with the fewest (adjusted odds ratio, 3.81; 95% confidence interval, 1.44-10.14; P = .007). No other workload measures were significantly associated with burnout. No efficiency variables were significantly associated with burnout in the main analysis; however, in a subset of clinicians for whom note entry data were available, clinicians in the top quartile of copy and paste use were significantly less likely to report burnout, with an adjusted odds ratio of 0.22 (95% confidence interval, 0.05-0.93; P = .039). Discussion High volumes of patient call messages were significantly associated with clinician burnout, even when accounting for other measures of workload and efficiency. In the EHR, “patient calls” encompass many of the inbox tasks occurring outside of face-to-face visits and likely represent an important target for improving clinician well-being. Conclusions Our results suggest that increased workload is associated with burnout and that EHR efficiency tools are not likely to reduce burnout symptoms, with the exception of copy and paste.

scholarly journals Optimizing the electronic health record: An inpatient sprint addresses provider burnout and improves electronic health record satisfaction

2020 ◽  
Author(s):  
Jennifer R Simpson ◽  
Chen-Tan Lin ◽  
Amber Sieja ◽  
Stefan H Sillau ◽  
Jonathan Pell
Keyword(s):  
Confidence Interval ◽  
Electronic Health Record ◽  
Health Record ◽  
Advanced Practice ◽  
Log Data ◽  
Net Promoter Score ◽  
Net Promoter ◽  
Electronic Health ◽  
Emotional Recovery ◽  
Very High

Abstract Objective We sought reduce electronic health record (EHR) burden on inpatient clinicians with a 2-week EHR optimization sprint. Materials and Methods A team led by physician informaticists worked with 19 advanced practice providers (APPs) in 1 specialty unit. Over 2 weeks, the team delivered 21 EHR changes, and provided 39 one-on-one training sessions to APPs, with an average of 2.8 hours per provider. We measured Net Promoter Score, thriving metrics, and time spent in the EHR based on user log data. Results Of the 19 APPs, 18 completed 2 or more sessions. The EHR Net Promoter Score increased from 6 to 60 postsprint (1.0; 95% confidence interval, 0.3-1.8; P = .01). The NPS for the Sprint itself was 93, a very high rating. The 3-axis emotional thriving, emotional recovery, and emotional exhaustion metrics did not show a significant change. By user log data, time spent in the EHR did not show a significant decrease; however, 40% of the APPs responded that they spent less time in the EHR. Conclusions This inpatient sprint improved satisfaction with the EHR.

scholarly journals 29 Predicting Unplanned Readmission and Death After Hospital Discharge: How Do Frailty Tools Compare to Electronic Health Record Frailty Markers?

2021 ◽  
Vol 50 (Supplement_1) ◽  
pp. i7-i11
Author(s):  
A Anand ◽  
Y Yong Tew ◽  
J Hao Chan ◽  
P Keeling ◽  
S D Shenkin ◽  
...  
Keyword(s):  
Electronic Health Record ◽  
Hospital Discharge ◽  
Royal Infirmary ◽  
Unplanned Readmission ◽  
Health Record ◽  
Clinical Frailty Scale ◽  
Standard Deviation Increase ◽  
Face To Face ◽  
Hospitalised Patients ◽  
Electronic Health

Abstract Introduction Numerous frailty tools and definitions have been described. Amongst hospitalised patients, the validity of face-to-face instruments may be confounded by acute illness. However, patient assessment after recovery at the point of hospital discharge, or recognition of electronic health record (EHR) frailty markers, may overcome this issuep. Methods In a consented, prospective observational cohort study, we recruited patients ≥70 years old within 24 hours of expected discharge from the cardiology ward of the Royal Infirmary of Edinburgh. Three established frailty instruments were tested: the Fried phenotype, Short Physical Performance Battery and nurse-administered Clinical Frailty Scale (CFS). An unweighted 32-item EHR score was generated using frailty markers (e.g. falls risk, continence, cognition) recorded within mandated admission documentation. Comorbidity was assessed by count of chronic health conditions. Outcomes were a 90-day composite of unplanned readmission or death and 12-month mortality. Adjusted Cox modelling determined the hazard ratio (HR) per standard deviation increase in each frailty score. Results 186 patients (mean age 79 ± 6 years, 64% male) were included, of whom 55 (30%) had a 90-day composite outcome, and 21 (11%) died within 12 months. All four frailty tools were moderately correlated with age and comorbidity (Pearson’s r 0.21 to 0.43, all p < 0.05). The Fried phenotype (HR 1.47, 95% CI 1.18–1.81), CFS (HR 1.24, 95% CI 1.01–1.51) and EHR score (HR 1.26, 95% CI 1.03–1.55) independently predicted 90-day readmission or death, after adjustment for age, sex and comorbidity. All frailty instruments were independent predictors of 12-month mortality, with age, sex and comorbidity losing predictive power (p > 0.05) once frailty was included in modelling. Conclusions At hospital discharge, the Fried phenotype and CFS added to age and comorbidity in risk prediction for future unplanned readmission or death. EHR frailty markers appeared comparable to face-to-face assessment. An automated trigger for high-risk patients using routine EHR data merits prospective evaluation.

Addressing Burnout Syndrome From a Critical Care Specialty Organization Perspective

2020 ◽  
Vol 31 (2) ◽  
pp. 158-166
Author(s):  
Kathryn L. Cochran ◽  
Kathleen Doo ◽  
Allison Squires ◽  
Tina Shah ◽  
Seppo Rinne ◽  
...  
Keyword(s):  
Health Care ◽  
Electronic Health Record ◽  
High Stress ◽  
Well Being ◽  
American Thoracic Society ◽  
Burnout Syndrome ◽  
Health Record ◽  
Cross Sectional ◽  
Electronic Health ◽  
At Home

Background: Health care specialty organizations are an important resource for their membership; however, it is not clear how specialty societies should approach combating stress and burnout on an organizational scale. Objective: To understand the prevalence of burnout syndrome in American Thoracic Society members, identify specialty-specific risk factors, and generate strategies for health care societies to combat burnout. Methods: Cross-sectional, mixed-methods survey in a sample of 2018 American Thoracic Society International Conference attendees to assess levels of burnout syndrome, work satisfaction, and stress. Results: Of the 130 respondents, 69% reported high stress, 38% met burnout criteria, and 20% confirmed chaotic work environments. Significant associations included sex and stress level; clinical time and at-home electronic health record work; and US practice and at-home electronic health record work. There were no significant associations between burnout syndrome and the selected demographics. Participants indicated patient care as the most meaningful aspect of work, whereas the highest contributors to burnout were workload and electronic health record documentation. Importantly, most respondents were unaware of available resources for burnout. Conclusions: Health care specialty societies have access to each level of the health system, creating an opportunity to monitor trends, disseminate resources, and influence the direction of efforts to reduce workplace stress and enhance clinician well-being.

scholarly journals Improve nurses’ well-being and joy in work: Implement true interprofessional teams and address electronic health record usability issues

2019 ◽  
Vol 67 (6) ◽  
pp. 791-797 ◽  
Author(s):  
Diane K. Boyle ◽  
Marianne Baernholdt ◽  
Jeffrey M. Adams ◽  
Susan McBride ◽  
Ellen Harper ◽  
...  
Keyword(s):  
Electronic Health Record ◽  
Well Being ◽  
Health Record ◽  
Interprofessional Teams ◽  
Electronic Health ◽  
Joy In Work

scholarly journals Promoting Quality Face-to-Face Communication during Ophthalmology Encounters in the Electronic Health Record Era

2020 ◽  
Vol 11 (01) ◽  
pp. 130-141
Author(s):  
Sally L. Baxter ◽  
Helena E. Gali ◽  
Michael F. Chiang ◽  
Michelle R. Hribar ◽  
Lucila Ohno-Machado ◽  
...  
Keyword(s):  
Electronic Health Record ◽  
High Volume ◽  
Health Record ◽  
Patient Centeredness ◽  
Face To Face ◽  
Single Sign On ◽  
Timing Data ◽  
After Hours ◽  
Electronic Health ◽  
Physician Patient

Abstract Objective To evaluate informatics-enabled quality improvement (QI) strategies for promoting time spent on face-to-face communication between ophthalmologists and patients. Methods This prospective study involved deploying QI strategies during implementation of an enterprise-wide vendor electronic health record (EHR) in an outpatient academic ophthalmology department. Strategies included developing single sign-on capabilities, activating mobile- and tablet-based applications, EHR personalization training, creating novel workflows for team-based orders, and promoting problem-based charting to reduce documentation burden. Timing data were collected during 648 outpatient encounters. Outcomes included total time spent by the attending ophthalmologist on the patient, time spent on documentation, time spent on examination, and time spent talking with the patient. Metrics related to documentation efficiency, use of personalization features, use of team-based orders, and note length were also measured from the EHR efficiency portal and compared with averages for ophthalmologists nationwide using the same EHR. Results Time spent on exclusive face-to-face communication with patients initially decreased with EHR implementation (2.9 to 2.3 minutes, p = 0.005) but returned to the paper baseline by 6 months (2.8 minutes, p = 0.99). Observed participants outperformed national averages of ophthalmologists using the same vendor system on documentation time per appointment, number of customized note templates, number of customized order lists, utilization of team-based orders, note length, and time spent after-hours on EHR use. Conclusion Informatics-enabled QI interventions can promote patient-centeredness and face-to-face communication in high-volume outpatient ophthalmology encounters. By employing an array of interventions, time spent exclusively talking with the patient returned to levels equivalent to paper charts by 6 months after EHR implementation. This was achieved without requiring EHR redesign, use of scribes, or excessive after-hours work. Documentation efficiency can be achieved using interventions promoting personalization and team-based workflows. Given their efficacy in preserving face-to-face physician–patient interactions, these strategies may help alleviate risk of physician burnout.

scholarly journals Real-world electronic health record identifies antimalarial underprescribing in patients with lupus nephritis

Lupus ◽  
2019 ◽  
Vol 28 (8) ◽  
pp. 977-985 ◽  
Author(s):  
W W Xiong ◽  
J B Boone ◽  
L Wheless ◽  
C P Chung ◽  
L J Crofford ◽  
...  
Keyword(s):  
Electronic Health Record ◽  
Real World ◽  
Lupus Erythematosus ◽  
Odds Ratio ◽  
Health Record ◽  
Urine Protein ◽  
Provider Characteristics ◽  
Reduce Disease Activity ◽  
Disease Damage ◽  
Electronic Health

Antimalarials (AMs) reduce disease activity and improve survival in patients with systemic lupus erythematosus (SLE), but studies have reported low AM prescribing frequencies. Using a real-world electronic health record cohort, we examined if patient or provider characteristics impacted AM prescribing. We identified 977 SLE cases, 94% of whom were ever prescribed an AM. Older patients and patients with SLE nephritis were less likely to be on AMs. Current age (odds ratio = 0.97, p < 0.01) and nephritis (odds ratio = 0.16, p < 0.01) were both significantly associated with ever AM use after adjustment for sex and race. Of the 244 SLE nephritis cases, only 63% were currently on AMs. SLE nephritis subjects who were currently prescribed AMs were more likely to be followed by a rheumatologist than a nephrologist and less likely to have undergone dialysis or renal transplant (both p < 0.001). Non-current versus current SLE nephritis AM users had higher serum creatinine ( p < 0.001), higher urine protein ( p = 0.05), and lower hemoglobin levels ( p < 0.01). As AMs reduce disease damage and improve survival in patients with SLE, our results demonstrate an opportunity to target future efforts to improve prescribing rates among multi-specialty providers.

scholarly journals Electronic health record alerts for acute kidney injury: multicenter, randomized clinical trial

BMJ ◽  
2021 ◽  
pp. m4786
Author(s):  
F Perry Wilson ◽  
Melissa Martin ◽  
Yu Yamamoto ◽  
Caitlin Partridge ◽  
Erica Moreira ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Relative Risk ◽  
Confidence Interval ◽  
Electronic Health Record ◽  
Usual Care ◽  
Primary Outcome ◽  
Kidney Injury ◽  
Health Record ◽  
Care Practices ◽  
Electronic Health

Abstract Objective To determine whether electronic health record alerts for acute kidney injury would improve patient outcomes of mortality, dialysis, and progression of acute kidney injury. Design Double blinded, multicenter, parallel, randomized controlled trial. Setting Six hospitals (four teaching and two non-teaching) in the Yale New Haven Health System in Connecticut and Rhode Island, US, ranging from small community hospitals to large tertiary care centers. Participants 6030 adult inpatients with acute kidney injury, as defined by the Kidney Disease: Improving Global Outcomes (KDIGO) creatinine criteria. Interventions An electronic health record based “pop-up” alert for acute kidney injury with an associated acute kidney injury order set upon provider opening of the patient’s medical record. Main outcome measures A composite of progression of acute kidney injury, receipt of dialysis, or death within 14 days of randomization. Prespecified secondary outcomes included outcomes at each hospital and frequency of various care practices for acute kidney injury. Results 6030 patients were randomized over 22 months. The primary outcome occurred in 653 (21.3%) of 3059 patients with an alert and in 622 (20.9%) of 2971 patients receiving usual care (relative risk 1.02, 95% confidence interval 0.93 to 1.13, P=0.67). Analysis by each hospital showed worse outcomes in the two non-teaching hospitals (n=765, 13%), where alerts were associated with a higher risk of the primary outcome (relative risk 1.49, 95% confidence interval 1.12 to 1.98, P=0.006). More deaths occurred at these centers (15.6% in the alert group v 8.6% in the usual care group, P=0.003). Certain acute kidney injury care practices were increased in the alert group but did not appear to mediate these outcomes. Conclusions Alerts did not reduce the risk of our primary outcome among patients in hospital with acute kidney injury. The heterogeneity of effect across clinical centers should lead to a re-evaluation of existing alerting systems for acute kidney injury. Trial registration ClinicalTrials.gov NCT02753751 .

Electronic Health Record Optimization and Clinician Well-Being: A Potential Roadmap Toward Action

2020 ◽  
Author(s):  
Tina Shah ◽  
Andrea Borondy Kitts ◽  
Jeffrey A. Gold ◽  
Keith Horvath ◽  
Alex Ommaya ◽  
...  
Keyword(s):  
Electronic Health Record ◽  
Well Being ◽  
Health Record ◽  
Electronic Health

scholarly journals Association of Medical Directors of Information Systems Consensus on Inpatient Electronic Health Record Documentation

2013 ◽  
Vol 04 (02) ◽  
pp. 293-303 ◽  
Author(s):  
L. Ozeran ◽  
C. Hamann ◽  
W. Bria ◽  
J. Shoolin
Keyword(s):  
Information Systems ◽  
Electronic Health Record ◽  
Clinical Care ◽  
Ease Of Use ◽  
Health Record ◽  
Electronic Documentation ◽  
Medical Directors ◽  
Electronic Health ◽  
Copy And Paste ◽  
The Right

SummaryIn 2013, electronic documentation of clinical care stands at a crossroads. The benefits of creating digital notes are at risk of being overwhelmed by the inclusion of easily importable detail. Providers are the primary authors of encounters with patients. We must document clearly our understanding of patients and our communication with them and our colleagues. We want to document efficiently to meet without exceeding documentation guidelines. We copy and paste documentation, because it not only simplifies the documentation process generally, but also supports meeting coding and regulatory requirements specifically. Since the primary goal of our profession is to spend as much time as possible listening to, understanding and helping patients, clinicians need information technology to make electronic documentation easier, not harder. At the same time, there should be reasonable restrictions on the use of copy and paste to limit the growing challenge of ‘note bloat’. We must find the right balance between ease of use and thoughtless documentation. The guiding principles in this document may be used to launch an interdisciplinary dialogue that promotes useful and necessary documentation that best facilitates efficient information capture and effective display. Citation: Shoolin J, Ozeran L, Hamann C, Bria W. II. Association of Medical Directors of Information Systems Consensus on Inpatient Electronic Health Record Documentation. Appl Clin Inf 2013; 4: 293–303http://dx.doi.org/10.4338/ACI-2013-02-R-0012

scholarly journals Is a switch to a different electronic health record associated with a change in patient satisfaction?

2020 ◽  
Vol 27 (6) ◽  
pp. 867-876 ◽  
Author(s):  
Frederick North ◽  
Jennifer L Pecina ◽  
Sidna M Tulledge-Scheitel ◽  
Rajeev Chaudhry ◽  
John C Matulis ◽  
...  
Keyword(s):  
Patient Satisfaction ◽  
Confidence Interval ◽  
Electronic Health Record ◽  
Piecewise Linear ◽  
Health Record ◽  
Patient Response ◽  
Survey Questions ◽  
Before And After ◽  
Electronic Health ◽  
Financial Impacts

Abstract Objective Financial impacts associated with a switch to a different electronic health record (EHR) have been documented. Less attention has been focused on the patient response to an EHR switch. The Mayo Clinic was involved in an EHR switch that occurred at 6 different locations and with 4 different “go-live” dates. We sought to understand the relationship between patient satisfaction and the transition to a new EHR. Materials and Methods We used patient satisfaction data collected by Press Ganey from July 2016 through December 2019. Our patient satisfaction measure was the percent of patients responding “very good” (top box) to survey questions. Twenty-four survey questions were summarized by Press Ganey into 6 patient satisfaction domains. Piecewise linear regression was used to model patient satisfaction before and after the EHR switch dates. Results Significant drops in patient satisfaction were associated with the EHR switch. Patient satisfaction with access (ease of getting clinic on phone, ease of scheduling appointments, etc.) was most affected (range of 6 sites absolute decline: -3.4% to -8.8%; all significant at 99% confidence interval). Satisfaction with providers was least affected (range of 6 sites absolute decline: -0.5% to -2.8%; 4 of 6 sites significant at 99% confidence interval). After 9-15 months, patient satisfaction with access climbed back to pre-EHR switch levels. Conclusions Patient satisfaction in several patient experience domains dropped significantly and stayed lower than pre–“go-live” for several months after a switch in EHR. Satisfaction with providers declined less than satisfaction with access.

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