The time that physicians spend on online paperwork may be correlated with burnout, according to a study affiliated with the University of Toronto’s Dalla Lana School of Public Health.
The study, conducted among physicians in Rhode Island, explored the relationship between their self-reported burnout and their use of health information technology (HIT). It found a positive correlation between burnout and the use of the technology in the state.
However, these results may not be generalizable to Canada, as the research did not include Canadian participants.
What is HIT?
HIT is a broad term that encompasses different types of computer programs and resources that health professionals use for their clinical practice. Examples include electronic health records (EHR); patient portals, which are secure websites where patients can receive test results; and e-prescriptions.
The technology aims to improve the flow of information between health care providers and patients, as well as increase the quality of patient care.
Dr. Rebekah Gardner, the lead author of the study and an associate professor of medicine at Brown University, explained to The Varsity that she became interested in this topic because she has “been personally affected by [the legislation] and [has] experienced [her] colleagues’ growing pains, in terms of learning how to use EHR.”
The study in focus
Due to the lack of research before widespread implementation, health centric advisors developed a survey — as mandated by the Rhode Island government — to measure the impacts of this technology on practicing physicians. This survey was sent to all physicians in Rhode Island, asking them to rate various feelings related to burnout on a one-to-five point scale. Forty-three per cent of the subjects — 1,792 physicians — responded, and of those respondents, 26 per cent had experienced burnout.
Burnout is defined in the research paper as a set of symptoms or feelings that people have, such as emotional exhaustion or decreased job satisfaction.
These results are important to understanding the scope of the problem, because burnout has adverse impacts on the health care system. It is associated with increased medical errors, absenteeism, reduced quality of work, higher rates of turnover, substance use disorder, and medical malpractice.
This study demonstrated the widespread prevalence of technology related stress and the measurability aspect of technology-related stress. Participants who reported insufficient time when it came to documentation had a 2.8 times higher likelihood of suffering from burnout.
Potential reasons behind the conclusions
Gardner explains some potential reasons for this result.
“Documentation is very time consuming and [can create] a lot of extra desk work for every office visit with a patient… this cuts into time spent with family or time spent sleeping,” she said. Physicians are generally not reimbursed for this time spent, according to the paper.
“Technology can metaphorically and literally disrupt the interaction between patients and doctors, and patient interaction is often an antidote to burnout.”
Burnout can also create a burden on the health care system.
“Burnout can result in unnecessary tests ordered and absenteeism requiring alternative sources to cover a physician’s shift,” said Daniel Harris, a co-author of the study and a second-year PhD student at the Dalla Lana School of Public Health, to The Varsity.
Nonetheless, not all physicians found using HIT to be stressful. Gardner found that some physicians believed HIT was extraordinarily useful. She also found that not all burnout was related to technology and burnout differed across various specialties.
“In other specialties, you’re going to miss the mark [if you just focus on HIT],” said Gardner. It may be productive for researchers to focus on different factors to “get to the root of burnout in that particular physician cohort,” she continued.
Future steps of research
However, there are limitations to this study. Harris explains that because this survey was cross-sectional, researchers are unable to establish causation.
Researchers must ensure there is a temporal sequence to establish causality, he noted. “We don’t know [whether HIT or burnout] came first,” he said, due to the design of the study. “You could potentially imagine a situation where someone is already very burned out, and that leads them to then use their EHR more at home.”
In addition, Gardner highlighted the lack of anonymity in this survey as potentially impacting the results of the study. Physicians may not have been able to, or wanted to, share the full extent of their burnout without anonymity.
Future steps include perhaps recruiting a larger sample across various states or health systems, exploring the factors that contribute to burnout in greater detail, and anonymizing the survey.
While future research is needed to generalize these results Canada, HIT is pervasive in health care and it could be a factor that contributes to burnout in Canadian health care providers.