A Somewhat Interesting Study OF EHR Use and Burnout In Australia. Maybe Worth A Browse.

This study appeared last week:

Digital medical record systems causing fatigue and burnout in health staff

August 31, 2021 — 8.43pm

The inability of doctors and nurses to properly use electronic record-keeping systems remains the biggest challenge to how well the systems perform across Australia, new research has found.

Over the past few years, all states and territories have moved to some form of electronic medical record system (EMR) to replace old paper records. 

The first large-scale study into the use of EMRs across the country has found smaller venues, such as GP clinics, are integrating the systems better than larger facilities, such as hospitals, which are struggling with a one-size-fits-all approach. 

Lead author Sheree Lloyd, from Griffith University’s School of Applied Psychology, said problems experienced with EMRs contributed to fatigue and burnout in health staff, as well as more errors. 

“[Governments] have made huge investments in these electronic medical record systems, and poor usability prevents our hospital and health systems from utilising their full benefit,” Dr Lloyd said.

“Usability must be considered a primary feature [of EMRs] because we’ve got a workforce that is already burnt out, stressed and fatigued.”

The study, which was led by Griffith University in collaboration with Monash University, the Royal Melbourne Hospital, the University of Wollongong, and the Australasian Institute of Digital Health, found doctors in general practice and other primary-care facilities expressed greater satisfaction with EMRs compared to nurses.

While that was flipped in the hospital sector, where nurses were more satisfied than doctors, overall, the satisfaction and take-up levels were lower in hospitals than in primary care.

Co-author Chris Bain, a professor of practice in digital health at Monash University, said Australia needed to learn the lessons that had already been worked through overseas, especially in the United States.

……

The research has been published in The International Journal of Medical Informatics.

More here:

https://www.smh.com.au/national/queensland/digital-medical-record-systems-causing-fatigue-and-burnout-in-health-staff-20210831-p58nlb.html

Here is the abstract:

A National Survey of EMR Usability: Comparisons between medical and nursing professions in the hospital and primary care sectors in Australia and Finland

Author links open overlay pane

Sheree Lloyd^a Karrie Long^b Abraham Oshni Alvandi^c Josie Di Donato^d Yasmine Probst^ef Jeremy Roach^g Christopher Bain^h

Highlights

• Usability can be measured in the Australian context using the NuHISS developed by Finnish researchers.

• Impressions differ between nurses and medical professionals in relation to EMR usability.

• Impressions vary within professional groups and across sectors in the Australian context.

• Comparisons between countries are difficult as contexts where clinicians practice and EMR systems differ.

Abstract

Background

Electronic Medical Record Systems (EMRs) are now part of nursing and medical professionals daily work in the acute and primary care sectors in Australia. Usability is an important factor in their successful adoption and impacts upon clinical workflow, safety and quality, communication, and collaboration. This study replicates a significant body of work conducted by Finnish researchers applying a usability focused survey to understand medical and nursing professionals’ experiences in the Australian context. As we implement EMRs across health systems, their usability and design to support clinicians to effectively deliver and document care, is essential.

Methods

We conducted an observational study using a cross sectional survey, the National Usability-Focused HIS Scale (NuHISS) developed and validated by Finnish researchers. For this study 13 usability statements collected clinician impressions of EMRs related to technical quality, ease of use, benefits, and collaboration. We report the responses from medical and nursing professionals working in clinical practice settings in Australia, including primary care and hospital sectors in 2020.

Results

Nursing and medical professionals have different experiences with EMR usability. This depends on the sector they work in and the usability feature measured. In our sample, technical quality features were more positively experienced by doctors in the primary care sector than nurses as well as ease of obtaining patient information and prevention of errors. In the hospital sector nurses experiences with EMRs were more positive with respect to support for routine task completion, learnability, ease of obtaining patient information and entry of patient data.

Conclusions

The NuHISS is a suitable tool for measuring the usability experiences of Australian clinicians and the EMRs utilised. Differences in usability experiences were noted between professional groups and sectors. A focus on the usability perspectives of clinicians when enhancing or developing EMR solutions is advocated.

Here is the link:

https://news.griffith.edu.au/2021/09/01/emr-study-reveals-divide-between-hospital-and-primary-care-sectors/

There is also a press release on the study.

Problems with EMR cause burnout, increased errors: study

Wednesday, 01 September, 2021

Problems with electronic medical record systems (EMRs) contribute to fatigue, burnout and increased errors, according to a study on EMR usability in Australia.

The study, led by Griffith University, captured views from medical, nursing and allied health professionals across the acute, primary and community care sectors. It found that nursing and medical professionals have differing experiences depending on where they work.

Results showed technical and quality features were more positively experienced by doctors in the primary care sector than nurses, as well as ease of obtaining patient information and prevention of errors.

In the hospital sector, nurses’ experiences with EMRs were more positive with regards to support for routine task completion, learnability, ease of obtaining patient information and entry of patient data.

Medical professional respondents working in the hospital sector were less satisfied with usability features than their primary care counterparts (routine task completion, prevention of errors, medication mistakes, patient data).

“Usability features of information exchange and collaboration for clinicians across services and with patients is critical to reduce complications such as missed care, medication errors, compliance and re-presentation,’’ said Dr Sheree Lloyd from Griffith University’s School of Applied Psychology.

“As well as the likelihood of increased errors, problems with EMRs can lead to fatigue and burnout.

“In the middle of a global pandemic, now more than ever we need to have a digitised system that is effective and easy to use for both medical and nursing professionals across sectors, but what we have found is that most EMRs have been designed as data collection tools rather than collaboration tools.

“In addition, most EMR systems used in Australian hospitals were developed in the US and may not be aligned to the workflows and practices of the Australian healthcare system.”

Another factor the researchers found that may have impeded usability was respondents being largely older, more experienced clinicians who, prior to EMR implementation, were likely expert users of paper-based record systems.

“While this varies from state to state, comprehensive EMR systems in hospitals have tended to be implemented later than those in the primary and community care sector,’’ said Dr Chris Bain, a Professor of Practice in Digital Health at Monash University.

“EMRs have traditionally targeted the role of doctors and have been designed from a biomedical perspective, but now there’s much more emphasis on a collaborative approach to health and wellbeing with a variety of clinicians providing medical care to patients,’’ he said.

Research partners for the study, claimed to be the first large-scale research on EMR usability in Australia, included Monash University, Royal Melbourne Hospital, the University of Wollongong and the Australasian Institute of Digital Health.

This study was based on a large-scale Finnish study to understand medical and nursing professionals’ experiences in the Australian context. The research team is hoping to repeat the study in 2022 to measure changes in usability and to gain a more complete picture of clinician concerns.

Here is the link:

https://www.hospitalhealth.com.au/content/technology/news/problems-with-emr-cause-burnout-increased-errors-study-610244408

I have to point out that it looks like the study was conducted in peak Wave 1 COVID19 pandemic so discussion of issues like stress and burnout might be hard to interpret!

I am also sightly bemused by the Finnish connection. Surely we have user interface and usability experts in Australia?

Also, other than grumbling that full text of the article is not freely available, I think it is vital to point out how different hospital and GP based systems are, in both purpose and intent, which seems to make comparative comments tricky.

Overall, when I finished reading what is available, I was left wondering just what this study added and given GP and Hospital EMR have been in use for years just what as desired as an outcome.

What do others think?

David