TY - JOUR
T1 - Perceived electronic health record usability as a predictor of task load and burnout among US physicians
T2 - Mediation analysis
AU - Melnick, Edward R.
AU - Harry, Elizabeth
AU - Sinsky, Christine A.
AU - Dyrbye, Liselotte N.
AU - Wang, Hanhan
AU - Trockel, Mickey Todd
AU - West, Colin P.
AU - Shanafelt, Tait
N1 - Funding Information:
The authors would like to thank Bidisha Nath, MD, MPH, for her contribution to the literature search and manuscript coordination. Funding for this study was provided by the Stanford Medicine WellMD Center, the American Medical Association, and the Mayo Clinic Department of Medicine Program on Physician Well-Being. ERM is supported in part by two American Medical Association Practice Transformation Initiatives and the National Institute on Drug Abuse of the National Institutes of Health under Award Number UH3DA047003. The content is solely the responsibility of the authors and does not necessarily represent the official views of the American Medical Association or the National Institutes of Health.
Publisher Copyright:
© 2020 Journal of Medical Internet Research. All rights reserved.
PY - 2020/12
Y1 - 2020/12
N2 - Background: Electronic health record (EHR) usability and physician task load both contribute to physician professional burnout. The association between perceived EHR usability and workload has not previously been studied at a national level. Better understanding these interactions could give further information as to the drivers of extraneous task load. Objective: This study aimed to determine the relationship between physician-perceived EHR usability and workload by specialty and evaluate for associations with professional burnout. Methods: A secondary analysis of a cross-sectional survey of US physicians from all specialties was conducted from October 2017 to March 2018. Among the 1250 physicians invited to respond to the subsurvey analyzed here, 848 (67.8%) completed it. EHR usability was assessed with the System Usability Scale (SUS; range: 0-100). Provider task load (PTL) was assessed using the mental demand, physical demand, temporal demand, and effort required subscales of the National Aeronautics and Space Administration Task Load Index (range: 0-400). Burnout was measured using the Maslach Burnout Inventory. Results: The mean scores were 46.1 (SD 22.1) for SUS and 262.5 (SD 71.7) for PTL. On multivariable analysis adjusting for age, gender, relationship status, medical specialty, practice setting, hours worked per week, and number of nights on call per week, physician-rated EHR usability was associated with PTL, with each 1-point increase in SUS score (indicating more favorable) associated with a 0.57-point decrease in PTL score (P<.001). On mediation analysis, higher SUS score was associated with lower PTL score, which was associated with lower odds of burnout. Conclusions: A strong association was observed between EHR usability and workload among US physicians, with more favorable usability associated with less workload. Both outcomes were associated with the odds of burnout, with task load acting as a mediator between EHR usability and burnout. Improving EHR usability while decreasing task load has the potential to allow practicing physicians more working memory for medical decision making and patient communication.
AB - Background: Electronic health record (EHR) usability and physician task load both contribute to physician professional burnout. The association between perceived EHR usability and workload has not previously been studied at a national level. Better understanding these interactions could give further information as to the drivers of extraneous task load. Objective: This study aimed to determine the relationship between physician-perceived EHR usability and workload by specialty and evaluate for associations with professional burnout. Methods: A secondary analysis of a cross-sectional survey of US physicians from all specialties was conducted from October 2017 to March 2018. Among the 1250 physicians invited to respond to the subsurvey analyzed here, 848 (67.8%) completed it. EHR usability was assessed with the System Usability Scale (SUS; range: 0-100). Provider task load (PTL) was assessed using the mental demand, physical demand, temporal demand, and effort required subscales of the National Aeronautics and Space Administration Task Load Index (range: 0-400). Burnout was measured using the Maslach Burnout Inventory. Results: The mean scores were 46.1 (SD 22.1) for SUS and 262.5 (SD 71.7) for PTL. On multivariable analysis adjusting for age, gender, relationship status, medical specialty, practice setting, hours worked per week, and number of nights on call per week, physician-rated EHR usability was associated with PTL, with each 1-point increase in SUS score (indicating more favorable) associated with a 0.57-point decrease in PTL score (P<.001). On mediation analysis, higher SUS score was associated with lower PTL score, which was associated with lower odds of burnout. Conclusions: A strong association was observed between EHR usability and workload among US physicians, with more favorable usability associated with less workload. Both outcomes were associated with the odds of burnout, with task load acting as a mediator between EHR usability and burnout. Improving EHR usability while decreasing task load has the potential to allow practicing physicians more working memory for medical decision making and patient communication.
KW - Burnout
KW - Cognitive load
KW - EHR
KW - Electronic health record
KW - NASA Task Load Index
KW - Physician
KW - Physician task load
KW - Stress
KW - System Usability Scale
KW - Usability
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U2 - 10.2196/23382
DO - 10.2196/23382
M3 - Article
C2 - 33289493
AN - SCOPUS:85098064628
SN - 1439-4456
VL - 22
JO - Journal of medical Internet research
JF - Journal of medical Internet research
IS - 12
M1 - e23382
ER -