A Couple Of Interesting Articles On EHR Use and Usability And The Associated Impacts.

First we had this which shows how user hostile systems hurt the user and increase the risk of burnout.

Mayo Clinic study links EHR usability with clinician burnout

Researchers sought to assess and benchmark how physicians view electronic health record usability, as defined by a standardized metric, and use that to evaluate how poor UX correlates with feelings of job frustration and burnout.

By Mike Miliard

November 15, 2019 09:20 AM

Here's a sentence that does not mince words: "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."

WHY IT MATTERS
That's the conclusion of a new study published in Mayo Clinic Proceedings, which sought to assess and benchmark how physicians view electronic health record usability, as defined by a standardized metric, and use that to evaluate how poor usability correlates with feelings of burnout.

Researchers polled U.S. physicians across all specialties in 2017 and 2018, using the American Medical Association Physician Masterfile. Nearly 5,200 completed the surveys, with a random one-quarter of those respondents also asked to take a subsurvey evaluating their EHR thoughts on usability; 870 completed that second survey.

The physicians' assessments of EHR usability were scored using the System Usability Scale, a 1-100 rating, which was then "normalized to percentile rankings across more than 1300 previous studies from other industries." Burnout, meanwhile, was tracked using the Maslach Burnout Inventory.

The results? Mean SUS score was 45.9 – good for the bottom 9% when viewed in the context of  other UX studies in other industries. Researchers categorized that as "not acceptable," assigning a letter grade of F.

With "multivariate analysis 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," according to the Mayo Clinic study.

 More info here:

https://www.healthcareitnews.com/news/mayo-clinic-study-links-ehr-usability-clinician-burnout

Here is the abstract.

The Association Between Perceived Electronic Health Record Usability and Professional Burnout Among US Physicians

Edward R. Melnick, MD, MHS^a

Liselotte N. Dyrbye, MD, MHPE^b

Christine A. Sinsky, MD^c

Mickey Trockel, MD, PhD^d

Colin P. West, MD, PhD^b,e

Laurence Nedelec, PhD^f

Michael A. Tutty, PhD^c

Tait Shanafelt, MD^f

Abstract

Objective

To describe and benchmark physician-perceived electronic health record (EHR) usability as defined by a standardized metric of technology usability and evaluate the association with professional burnout among physicians.

Participants and Methods

This cross-sectional survey of US physicians from all specialty disciplines was conducted between October 12, 2017, and March 15, 2018, using the American Medical Association Physician Masterfile. Among the 30,456 invited physicians, 5197 (17.1%) completed surveys. A random 25% (n=1250) of respondents in the primary survey received a subsurvey evaluating EHR usability, and 870 (69.6%) completed it. EHR usability was assessed using the System Usability Scale (SUS; range 0-100). SUS scores were normalized to percentile rankings across more than 1300 previous studies from other industries. Burnout was measured using the Maslach Burnout Inventory.

Results

Mean ± SD SUS score was 45.9±21.9. A score of 45.9 is in the bottom 9% of scores across previous studies and categorized in the “not acceptable” range or with a grade of F. On multivariate analysis 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 (odds ratio, 0.97; 95% CI, 0.97-0.98; P<.001).

Conclusion

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.

Here is the link:

https://www.mayoclinicproceedings.org/article/S0025-6196(19)30836-5/abstract

I think the conclusion says it all - other than a critique of the article from HISTalk - about 1/2 way down the page!

You can read this here:

https://histalk2.com/2019/11/17/monday-morning-update-11-18-19/
 

I will leave it to the reader to balance the competing views!

Additionally we have this on sex differences in EHR use between men and women.

Differences in Ambulatory EHR Use Patterns for Male vs. Female Physicians

Case Study · November 13, 2019

Kiran Gupta, MD, MPH, Sara G. Murray, MD, MAS, Urmimala Sarkar, MD, MPH, Michelle Mourad, MD & Julia Adler-Milstein, PhD

UCSF Health

Widespread adoption of electronic health records (EHRs) has transformed patient care. While prior studies have linked EHR use to physician burnout, understanding different approaches to EHR use facilitates a more nuanced understanding of this relationship. Prior work has revealed that physician gender is tied to burnout as well as to patient expectations and outcomes. Therefore, in this study, we sought to understand differences in EHR use patterns — across an array of measures related to time spent on documentation, approaches to EHR documentation, and use of EHR tools — by physician gender for all ambulatory physicians (n = 1,336) at a large academic medical center. Measures were derived from EHR access logs and were reported on a per-physician-per-6-week-period basis over 1 year. On a per work relative value unit (wRVU) basis, women physicians spent more time in the EHR after hours on clinic days as well as on non-clinic days, spent more time handling messages in the system’s In Basket, and spent more time performing clinical review. Women also had different documentation patterns, including longer notes, a greater use of the copy/paste function, more patient contacts returned within 24 hours, and fewer visits closed on the same day. Finally, women used more documentation efficiency tools. These results offer new insights into how physicians differ in approaching EHR-related work, which will serve to inform opportunities for improving EHR workflow and addressing burnout.

The full article is here:

https://catalyst.nejm.org/ambulatory-ehr-patterns-physician-gender/

One paragraph summarises toe upshot of the study.

“Our results suggest that female physicians spend more time in the EHR after hours and on days off (including weekdays and weekends), document longer notes (with greater use of the copy/paste function), and address a higher percent of patient contacts within 24 hours. It is possible that these behaviors account for the lower level of same-day visit closure. We suspect that there is not a single factor driving these gender-based differences and believe that our findings may be due to a collection of factors — for example, communication styles, work preferences (e.g., when to perform work in order to achieve desired work-life balance), and patient expectations — that result in female physicians exhibiting different EHR use patterns.”

Overall we learn that usability really matters and we have to work harder to support female EHR users.

Well worth knowing.

David.