Amrita Sinha1, Tait D Shanafelt2,3, Mickey Trockel4, Hanhan Wang5, Christopher Sharp6. 1. Division of Pediatric Critical Care Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, California, United States. 2. Division of Hematology and General Internal Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, California, United States. 3. WellMD Center, Stanford University School of Medicine, Stanford, California, United States. 4. Division of Psychology and Behavioral Sciences, Department of General Psychiatry and Psychology, Stanford University School of Medicine, Stanford, California, United States. 5. WellMD & WellPhD Center, Stanford University School of Medicine, Stanford, California, United States. 6. Division of General Internal Medicine, Department of Medicine, Stanford University, Stanford, California, United States.
Abstract
BACKGROUND: Accumulating evidence indicates an association between physician electronic health record (EHR) use after work hours and occupational distress including burnout. These studies are based on either physician perception of time spent in EHR through surveys which may be prone to bias or by utilizing vendor-defined EHR use measures which often rely on proprietary algorithms that may not take into account variation in physician's schedules which may underestimate time spent on the EHR outside of scheduled clinic time. The Stanford team developed and refined a nonproprietary EHR use algorithm to track the number of hours a physician spends logged into the EHR and calculates the Clinician Logged-in Outside Clinic (CLOC) time, the number of hours spent by a physician on the EHR outside of allocated time for patient care. OBJECTIVE: The objective of our study was to measure the association between CLOC metrics and validated measures of physician burnout and professional fulfillment. METHODS: Physicians from adult outpatient Internal Medicine, Neurology, Dermatology, Hematology, Oncology, Rheumatology, and Endocrinology departments who logged more than 8 hours of scheduled clinic time per week and answered the annual wellness survey administered in Spring 2019 were included in the analysis. RESULTS: We observed a statistically significant positive correlation between CLOC ratio (defined as the ratio of CLOC time to allocated time for patient care) and work exhaustion (Pearson's r = 0.14; p = 0.04), but not interpersonal disengagement, burnout, or professional fulfillment. CONCLUSION: The CLOC metrics are potential objective EHR activity-based markers associated with physician work exhaustion. Our results suggest that the impact of time spent on EHR, while associated with exhaustion, does not appear to be a dominant factor driving the high rates of occupational burnout in physicians. Thieme. All rights reserved.
BACKGROUND: Accumulating evidence indicates an association between physician electronic health record (EHR) use after work hours and occupational distress including burnout. These studies are based on either physician perception of time spent in EHR through surveys which may be prone to bias or by utilizing vendor-defined EHR use measures which often rely on proprietary algorithms that may not take into account variation in physician's schedules which may underestimate time spent on the EHR outside of scheduled clinic time. The Stanford team developed and refined a nonproprietary EHR use algorithm to track the number of hours a physician spends logged into the EHR and calculates the Clinician Logged-in Outside Clinic (CLOC) time, the number of hours spent by a physician on the EHR outside of allocated time for patient care. OBJECTIVE: The objective of our study was to measure the association between CLOC metrics and validated measures of physician burnout and professional fulfillment. METHODS: Physicians from adult outpatient Internal Medicine, Neurology, Dermatology, Hematology, Oncology, Rheumatology, and Endocrinology departments who logged more than 8 hours of scheduled clinic time per week and answered the annual wellness survey administered in Spring 2019 were included in the analysis. RESULTS: We observed a statistically significant positive correlation between CLOC ratio (defined as the ratio of CLOC time to allocated time for patient care) and work exhaustion (Pearson's r = 0.14; p = 0.04), but not interpersonal disengagement, burnout, or professional fulfillment. CONCLUSION: The CLOC metrics are potential objective EHR activity-based markers associated with physician work exhaustion. Our results suggest that the impact of time spent on EHR, while associated with exhaustion, does not appear to be a dominant factor driving the high rates of occupational burnout in physicians. Thieme. All rights reserved.
Authors: Tait D Shanafelt; Michael R Oreskovich; Lotte N Dyrbye; Daniel V Satele; John B Hanks; Jeff A Sloan; Charles M Balch Journal: Ann Surg Date: 2012-04 Impact factor: 12.969
Authors: Christine A Sinsky; Adam Rule; Genna Cohen; Brian G Arndt; Tait D Shanafelt; Christopher D Sharp; Sally L Baxter; Ming Tai-Seale; Sherry Yan; You Chen; Julia Adler-Milstein; Michelle Hribar Journal: J Am Med Inform Assoc Date: 2020-04-01 Impact factor: 4.497
Authors: Christine Sinsky; Lacey Colligan; Ling Li; Mirela Prgomet; Sam Reynolds; Lindsey Goeders; Johanna Westbrook; Michael Tutty; George Blike Journal: Ann Intern Med Date: 2016-09-06 Impact factor: 25.391