June 16, 2023
Over the last few decades, the use of electronic health records (EHRs) has become widespread. While the addition of this tool has revolutionized medical practice, EHR use also has been identified as a key driver of physician burnout.
Because the impact of this trend has not been fully investigated among gastroenterology (GI) specialists, Mayo Clinic researchers conducted a retrospective study examining EHR usage among outpatient GI specialists. The results of this study were published in The American Journal of Gastroenterology (AJG) in 2023.
According to Francis A. Farraye, M.D., M.S., and Aman S. Bali, M.D., lead authors on the AJG article, the Mayo Clinic study is a departure from previously published research and offers some new insights into how EHR use impacts GI specialists. Dr. Farraye is a clinical investigator and gastroenterologist at Mayo Clinic's campus in Jacksonville, Florida, and Dr. Bali is a resident in internal medicine at Mayo Clinic.
"Burnout has been identified as a factor in clinicians' decisions to reduce hours and leave medical practice, so identifying factors contributing to high EHR burden is a very important endeavor. While previous literature has investigated the differences in EHR burden and focused on factors such as provider sex and specialty, the research that predated our study has largely focused on the primary care setting."
"Very little has been done to investigate and describe how these issues may apply to gastroenterology practice," adds Dr. Bali. "This prompted our interest in investigating EHR usage at our institution, and we used Epic's Signal analytics tool to fill this knowledge gap."
Methods
The researchers collected data from more than 16,000 appointments associated with 41 providers across Gastroenterology and Hepatology at Mayo Clinic in Florida during a six-month period in 2021. They analyzed EHR use by measuring overall active time in the EHR system per appointment to account for varying clinical time. Secondary measures included the amount of time that clinicians spent in Epic that occurred outside of scheduled hours (after 5:30 p.m. and before 7:00 a.m., and during weekends); the amount of time spent performing activities such as chart review, documentation and in-basket management; provider efficiency; and patient age.
The researchers compared metrics associated with three domains: sex, subspecialty category and training level (physicians versus nonphysician providers). Subspecialty categories included inflammatory bowel disease (IBD), hepatology (HEP), esophagus (ESO), advanced endoscopy (AE), and motility/irritable bowel syndrome (IBS). Nonphysician providers (NPPs) included advanced practice registered nurses and physician assistants.
Results
According to Drs. Farraye and Bali, the data revealed a number of interesting insights and trends worth noting:
- The amount of time in the EHR per appointment was similar among providers of both sexes.
- IBD and HEP specialists spent more time per appointment and more time outside regular working hours performing EHR-related tasks and clinical review when compared with other types of subspecialists.
- NPPs spent more time on EHR-related tasks during appointments when compared with physicians.
"Among IBD providers and hepatologists," explains Dr. Bali, "the EHR burden took the form of increased time spent in the EHR during each appointment performing clinical review, as well as additional time outside of scheduled hours on evenings, nights and weekends, also known as pajama time. For NPPs, the burden took the form of increased time spent working on in-basket inquiries, as well as a higher burden of medical advice request messages from patients."
"These findings are novel and identify important areas where further efforts may be directed to improve efficiency and reduce EHR burden for the groups being most affected," explains Dr. Farraye. "Studies assessing EHR burden at different institutions and practices, which may have varying patient care models and patient panel compositions, could help assess how consistent these trends are across institutions. That data could help us begin to identify best practices to improve efficiency in the EHR. Additional studies that directly assess indices of burnout amongst gastroenterologists, as well as focus groups composed of gastroenterology providers, could offer insight into how EHR use impacts workplace stress and job satisfaction, and help us identify specific factors associated with clinical workflow that are the most burdensome."
For more information
Bali AS, et al. Electronic health record burden among gastroenterology providers associated with subspecialty and training. The American Journal of Gastroenterology. In press.
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