Clinician burnout correlates with volume of EHR patient call messages

It’s no secret that health IT-associated clinician burnout – especially where electronic health record usage is concerned – is widespread. But a new study seeks to identify which individual EHR elements might be most associated with burnout.  

The study, published this week in the Journal of the American Medical Informatics Association, found that clinicians with high volumes of patient call messages had almost four times the odds of burnout compared to those with the fewest.

Researchers Dr. Ross Hilliard, Jacquelyn Haskell and Rebekah L. Gardner also found that EHR-based efficiency tools – except for the ability to copy and paste – were not associated with decreased odds of burnout.

“In fact, these suggested efficiency tools may not provide for or measure efficiency at all,” wrote the research team.


Researchers examined the EHR usage data from Epic for 422 physicians, advanced practice registered nurses and physician assistants who had also responded to the 2017 Rhode Island Department of Health Physician and Advanced Practice Provider Health Information Technology Survey. 

Noting that prior studies have linked inbox management volume, data entry tasks and documentation with burnout, study authors defined measures of workload to include the number of daily appointments; minutes spent reviewing patient charts; medication and non-medication orders authorized by the clinician; patient call and results messages received; and note length per visit in characters.    

Using those measures, the team found that on average, primary care clinicians had a higher workload than non-PCPs. PCPs and older clinicians were more likely to report symptoms of burnout.   

The team found that the number of patient call messages per week was significant in terms of burnout. Such messages included patient requests and questions, but also refill requests (that didn’t come in through an electronic interface), patient care forms and other tasks. 

“In many systems, these patient call messages are the workhorse tool for communication and coordination of care between visits,” wrote the researchers.

When it came to efficiency measures – such as precharting of notes, use of the Chart Search function, number of SmartPhrases and percent of orders placed from preference lists or SmartSets – none were associated with burnout, though top users of copy and paste were significantly less likely to report it.

Importantly, the study points out that “reading copy-and-pasted note content was independently associated with increased stress and burnout in a [separate] large study of ambulatory clinicians, suggesting that a decrease in burnout for the note writer may be offset by an increase in the note reader.”

“Neither a higher proportion of SmartTools use in notes nor use of transcription or voice recognition technology was associated with lower burnout prevalence,” wrote the researchers.

The study authors suggested that call volume measure might be correlated with increased burnout because “virtually all” of the tasks are uncompensated. They also suggested the connection could be related to lack of control over workload; an excessive amount of at-home EHR time; and a high proportion of work not requiring physician level skills.


As the researchers point out, unraveling the link between EHR use and burnout has been the subject of much intrigue, with researchers pointing to messaging improvements, training, usability and clinician buy-in as just a few strategies to improve satisfaction.

But other indicators suggest that other improvements are both possible and forthcoming.  

“Cerner has set out to make the physician experience easier with our AI technology,” said Dr. Jeffrey Wall, director and physician strategy executive at Cerner, during HIMSS19. 

According to Wall, the vendor has been innovating uses of analytics and real-time feedback to continuously optimize systems for a more person-centered user experience.


“In addition to delegating appropriate inbox messages to nonphysician staff and improving EHR usability, we recommend that future studies explore prospectively testing a model of EHR use characteristics predictive of burnout, so that individual institutions could provide customized assistance to clinicians,” researchers concluded.

Kat Jercich is senior editor of Healthcare IT News.
Twitter: @kjercich
Healthcare IT News is a HIMSS Media publication.

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