Edward R. Melnick, MD, MHS Assistant Professor of Emergency Medicine Program Director, Yale-VA Clinical Informatics Fellowship Program Principal Investigator, EMBED Trial Network Yale School of Medicine New Haven, CT 06519

Physicians Give Their Electronic Medical Records Systems an “F” for Usability

MedicalResearch.com Interview with:

Edward R. Melnick, MD, MHS Assistant Professor of Emergency Medicine Program Director, Yale-VA Clinical Informatics Fellowship Program Principal Investigator, EMBED Trial Network Yale School of Medicine New Haven, CT 06519

Dr. Melnick

Edward R. Melnick, MD, MHS
Assistant Professor of Emergency Medicine
Program Director, Yale-VA Clinical Informatics Fellowship Program
Principal Investigator, EMBED Trial Network
Yale School of Medicine
New Haven, CT 06519

MedicalResearch.com: What is the background for this study?

Response: We know that physicians are frustrated with their EHRs and that EHRs are a driver of burnout. This is the first study to measure these issues nationally.

We included a standardized metric of technology from other industries (System Usability Scale, SUS; range 0-100) on the AMA’s 2017 physician burnout survey. This metric has been used in >1300 other studies so we can compare where the EHR’s usability is to other everyday technologies. We are also able to measure the relationship between physicians’ perception of their EHR’s usability and the likelihood they are burned out.

MedicalResearch.com: What are the main findings?

Response: The mean SUS score of 45.9 is in the bottom 9% of scores across previous studies (from other industries). Adjusting for age, sex, medical specialty, practice setting, hours worked, and number of nights on call weekly, physician-rated EHR usability was independently associated with the odds of burnout with each 1 point more favorable SUS score associated with a 3% lower odds of burnout (OR 0.97; p < .001). The usability of current EHR systems received a grade of F by physician users when evaluated using a standardized metric of technology usability. A strong, dose-response relationship between EHR usability and the odds of burnout was observed. We also report some really compelling data on EHR usability by specialty (these tend to get a lot of engagement online).

MedicalResearch.com: How have EHRs affected physician productivity, ie the number of patients that can be seen in a session?

Our study did not address this. But anecdotally the burden of EHR use has decreased physician productivity as measured by patients per hour/session.

MedicalResearch.com: What should readers take away from your report?

Response: There is a large usability gap between EHRs/health IT and technology in other industries. There are many contributing factors to this gap. The key take away is that now it has been measured, so we can follow it over time. Which means that interventions that aim to improve EHR usability could be reliably assessed as we (hopefully) begin to close this gap.

MedicalResearch.com: What recommendations do you have for future research as a result of this work?

Response: We will also begin looking at actual EHR use patterns (as opposed to self-reported perceptions) to see how they relate to physician burnout, physician retention, and self-reported usability perceptions. To accelerate future improvements in EHR usability, we would like to identify top performing organizations and practices in EHR usability, assess their processes and identify best practices for local EHR optimization.

MedicalResearch.com: Is there anything else you would like to add?

Response: No disclosures. See attached editorial I wrote in 2017 with more on my take with why EHRs are limited and concludes with this statement:

Though clunky, the current electronic record is functional and reliable. But it is not yet usable as intended, and we have a way to go before it can routinely and effectively promote bedside interaction between patients and clinicians. Technologic innovation must focus on optimizing both the quality and quantity of time at the bedside. Only through such an approach can we foster an environment in which clinicians can listen to, care for, and heal their patients.

To do so, the healthcare industry—across its continuum—must invest appropriate resources and follow established design principles that put the needs of users first. Only then will we have an electronic health record that allows patients and clinicians to do things better than they could on paper and to interact in innovative ways. In the meantime, the sanctity of the clinician-patient relationship remains at risk.

Citation:

The Association Between Perceived Electronic Health Record Usability and Professional Burnout Among US Physicians
Melnick, Edward R. et al.
Mayo Clinic Proceedings, Volume 0, Issue 0

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Last Modified: Nov 15, 2019 @ 10:53 pm

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