How to make the electronic health record your friend.
Journal
Current opinion in pediatrics
ISSN: 1531-698X
Titre abrégé: Curr Opin Pediatr
Pays: United States
ID NLM: 9000850
Informations de publication
Date de publication:
01 10 2023
01 10 2023
Historique:
medline:
14
9
2023
pubmed:
26
5
2023
entrez:
26
5
2023
Statut:
ppublish
Résumé
The electronic health record (EHR) has become ubiquitous among healthcare providers. It has revolutionized how we care for patients allowing for instant access to records, improved order entry, and improved patient outcomes. However, it has also been implicated as a source of stress, burnout, and workplace dissatisfaction among its users. The article provides an overview of factors associated with burnout focusing on the pediatrician and pediatric subspecialist workflows and will summarize practical tips based on clinical informatics principles for addressing these factors. Several metrics related to EHR including training, efficiency and lack of usability have been cited as factors associated with burnout. Organizational, personal, and interpersonal factors as well as work culture are more associated with burnout than EHR use. Organizational strategies to address burnout include first monitoring metrics including physician satisfaction and wellbeing, incorporating mindfulness and teamwork, and decreasing stress from the EHR by providing training, standardized workflows, and efficiency tools. All clinicians should feel empowered to customize workflows and seek organizational help for improving EHR use.
Identifiants
pubmed: 37233610
doi: 10.1097/MOP.0000000000001261
pii: 00008480-990000000-00100
doi:
Types de publication
Review
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
579-584Informations de copyright
Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.
Références
Campanella P, Lovato E, Marone C, et al. The impact of electronic health records on healthcare quality: a systematic review and meta-analysis. Eur J Public Health 2016; 26:60–64.
Melnick ER, Fong A, Nath B, et al. Analysis of electronic health record use and clinical productivity and their association with physician turnover. JAMA Netw Open 2021; 4:e2128790.
Whalen K, Lynch E, Moawad I, et al. Transition to a new electronic health record and pediatric medication safety: lessons learned in pediatrics within a large academic health system. J Am Med Inform Assoc 2018; 25:848–854.
Council on Clinical Information Technology. Health information technology and the medical home. Pediatrics. 2011;127:978–82.
Jin J, Brown M, Sinsky C. Taming the electronic health record playbook. American Medical Association; 2023 Mar 31 [cited 2023 May 05]. Available at: https://www.ama-assn.org/system/files/steps-forward-taming-ehr-playbook.pdf .
American Medical Informatics Association. AMIA public policy principles and policy positions. American Medical Informatics Association; 2022 [cited 2023 May 05]. Available at: https://brand.amia.org/m/2e7af7b35c4b5154 .
Health IT. Strategy on reducing regulatory and administrative burden relating to the use of health IT and EHRs. Office of National Coordinator; 2020 Feb [cited 2023 May 05]. Available at: https://www.healthit.gov/sites/default/files/page/2020-02/BurdenReport_0.pdf .
Tong L, Wu H, Wang MD, Wang G. Introduction of medical genomics and clinical informatics integration for p-Healthcare. Prog Mol Biol Transl Sci 2022; 190:1–37.
Desai S, Mostaghimi A, Nambudiri VE. Clinical informatics subspecialists: characterizing a novel evolving workforce. J Am Med Inform Assoc 2020; 27:1711–1715.
United States Food and Drug Administration. 21st Century cures act. United States Food and Drug Administration; 2020 Jan 31 [cited 2023 May 05]. Available at: https://www.fda.gov/regulatory-information/selected-amendments-fdc-act/21st-century-cures-act .
Adler-Milstein J, Zhao W, Willard-Grace R, et al. Electronic health records and burnout: time spent on the electronic health record after hours and message volume associated with exhaustion but not with cynicism among primary care clinicians. J Am Med Inform Assoc 2020; 27:531–538.
Attipoe S, Hoffman J, Rust S, et al. Characterization of electronic health record use outside scheduled clinic hours among primary care pediatricians: retrospective descriptive task analysis of electronic health record access log data. JMIR Med Inform 2022; 10:e34787.
Holmgren AJ, Lindeman B, Ford EW. Resident physician experience and duration of electronic health record use. Appl Clin Inform 2021; 12:721–728.
Liljenquist K, Hurst R, Guerra LS, et al. Time spent at well child care visits for English- and Spanish-speaking parents. Acad Pediatr 2023; 23:359–362.
Peccoralo LA, Kaplan CA, Pietrzak RH, et al. The impact of time spent on the electronic health record after work and of clerical work on burnout among clinical faculty. J Am Med Inform Assoc 2021; 28:938–947.
Zhang X, Huang Y, Lee J, et al. Measuring telehealth visit length and schedule adherence using videoconferencing data. Telemed J E Health 2022; 28:976–984.
Chandawarkar A, Chaparro JD. Burnout in clinicians. Curr Probl Pediatr Adolesc Health Care 2021; 51:101104.
Nigri L, Carrasco-Sanz A, Pop TL, et al. Burnout in primary care pediatrics and the additional burden from the COVID-19 pandemic. J Pediatr 2023; 113447[Online ahead of print].
Chien KA, Thomas C, Cooley V, et al. Physician burnout in pediatric gastroenterology. J Pediatr Gastroenterol Nutr 2023; 76:25–32.
McPeek-Hinz E, Boazak M, Sexton JB, et al. Clinician burnout associated with sex, clinician type, work culture, and use of electronic health records. JAMA Netw Open 2021; 4:e215686.
Linzer M. Preventing burnout in academic medicine. Arch Intern Med 2009; 169:927–928.
Melnick ER, Sinsky CA, Dyrbye LN, et al. Association of perceived electronic health record usability with patient interactions and work-life integration among US physicians. JAMA Netw Open 2020; 3:e207374.
Tajirian T, Stergiopoulos V, Strudwick G, et al. The influence of electronic health record use on physician burnout: cross-sectional survey. J Med Internet Res 2020; 22:e19274.
Saag HS, Shah K, Jones SA, et al. Pajama time: working after work in the electronic health record. J Gen Intern Med 2019; 34:1695–1696.
Centers for Medicare & Medicaid Services. 1997 Documentation guidelines for evaluation and management services. Centers for Medicare & Medicaid Services; 1997 [cited 2023 May 05]. Available at: https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNEdWebGuide/Downloads/97Docguidelines.pdf .
Castaldi M, McNelis J. Introducing a clinical documentation specialist to improve coding and collectability on a surgical service. J Healthc Qual 2019; 41:e21–e29.
Diao X, Huo Y, Zhao S, et al. Automated ICD coding for primary diagnosis via clinically interpretable machine learning. Int J Med Inform 2021; 153:104543.
Zhao S, Diao X, Xia Y, et al. Automated ICD coding for coronary heart diseases by a deep learning method. Heliyon 2023; 9:e14037.
Rule A, Bedrick S, Chiang MF, Hribar MR. Length and redundancy of outpatient progress notes across a decade at an academic medical center. JAMA Netw Open 2021; 4:e2115334.
Steinkamp J, Kantrowitz JJ, Airan-Javia S. Prevalence and sources of duplicate information in the electronic medical record. JAMA Netw Open 2022; 5:e2233348.
Apathy NC, Hare AJ, Fendrich S, Cross DA. Early changes in billing and notes after evaluation and management guideline change. Ann Intern Med 2022; 175:499–504.
Lieu TA, Altschuler A, Weiner JZ, et al. Primary care physicians’ experiences with and strategies for managing electronic Messages. JAMA Netw Open 2019; 2:e1918287.
Linzer M, Levine R, Meltzer D, et al. 10 bold steps to prevent burnout in general internal medicine. J Gen Intern Med 2014; 29:18–20.
KLAS Research. Clinician training impact report. The Arch Collaborative; 2019 Sep 06 [cited 2023 May 05]. Available at: https://klasresearch.com/archcollaborative/report/clinician-training/303#:∼:text=Feedback%20from%20EHR%20users%20suggests%20that%205%E2%80%938%20total,so%20time-consuming%20that%20it%20contributes%20to%20clinician%20burnout .
Lakshminrusimha S, Olsen SL, Lubarsky DA. Behavioral economics in neonatology-balancing provider wellness and departmental finances. J Perinatol 2022; 42:683–688.
Rodriguez-Fernandez JM, Loeb JA, Hier DB. It's time to change our documentation philosophy: writing better neurology notes without the burnout. Front Digit Health 2022; 4:1063141.
Nguyen OT, Turner K, Charles D, et al. Implementing digital scribes to reduce electronic health record documentation burden among cancer care clinicians: a mixed-methods pilot study. JCO Clin Cancer Inform 2023; 7:e2200166.
Rotenstein LS, Apathy N, Holmgren AJ, Bates DW. Physician note composition patterns and time on the ehr across specialty types: a national, cross-sectional study. J Gen Intern Med 2023; 38:1119–1126.
Kahn D, Stewart E, Duncan M, et al. A prescription for note bloat: an effective progress note template. J Hosp Med 2018; 13:378–382.
McRae AE, Rowe JT, Friedes BD, et al. the impact of a note-writing session and standardized note template on medical student note length and quality. Acad Pediatr 2023; [Online ahead of print].
Hawa K, Janse S, Lee J, et al. Providing a constipation action plan to families of children with constipation decreases healthcare utilization. J Pediatr Gastroenterol Nutr 2022; 75:589–594.
Benoit A, Dykes P, Chang F, et al. Using electronic questionnaires to collect patient reported history. AMIA Annu Symp Proc 2007; 871.
Murray MF, Giovanni MA, Klinger E, et al. Comparing electronic health record portals to obtain patient-entered family health history in primary care. J Gen Intern Med 2013; 28:1558–1564.
Templeton K, Chan Yuen J, Lenz C, et al. Quality improvement initiative to improve timing of enteral feeds in pediatric acute pancreatitis. Pediatrics 2023; 151:e2022056700.
Apathy NC, Rotenstein L, Bates DW, Holmgren AJ. Documentation dynamics: note composition, burden, and physician efficiency. Health Serv Res 2023; 58:674–685.