Original Investigation
Health Informatics
June 9, 2020
Association of Electronic Health Record Use With Physician Fatigue and Efficiency
Saif Khairat, Cameron Coleman, Paige Ottmar, et al
JAMA Netw Open. 2020;3(6):e207385. doi:10.1001/jamanetworkopen.2020.7385
Question What is the association between electronic health record use and physician fatigue and efficiency?
Findings In this cross-sectional study of 25 physicians completing 4 simulated cases of intensive care unit patients in the electronic health record, all physicians experienced fatigue at least once and 80% experienced fatigue within the first 22 minutes of electronic health record use, which was associated with less efficient electronic health record use (more time, more clicks, and more screens) on the subsequent patient case.
Meaning Physicians experience electronic health record–related fatigue in short periods of continuous electronic health record use, which may be associated with inefficient and suboptimal electronic health record use.
Abstract
Importance The use of electronic health records (EHRs) is directly associated with physician burnout. An underlying factor associated with burnout may be EHR-related fatigue owing to insufficient user-centered interface design and suboptimal usability.
Objective To examine the association between EHR use and fatigue, as measured by pupillometry, and efficiency, as measured by mouse clicks, time, and number of EHR screens, among intensive care unit (ICU) physicians completing a simulation activity in a prominent EHR.
Design, Setting, and Participants A cross-sectional, simulation-based EHR usability assessment of a leading EHR system was conducted from March 20 to April 5, 2018, among 25 ICU physicians and physician trainees at a southeastern US academic medical center. Participants completed 4 simulation patient cases in the EHR that involved information retrieval and task execution while wearing eye-tracking glasses. Fatigue was quantified through continuous eye pupil data; EHR efficiency was characterized through task completion time, mouse clicks, and EHR screen visits. Data were analyzed from June 1, 2018, to August 31, 2019.
Main Outcomes and Measures Primary outcomes were physician fatigue, measured by pupillometry (with lower scores indicating greater fatigue), and EHR efficiency, measured by task completion times, number of mouse clicks, and number of screens visited during EHR simulation.
Results The 25 ICU physicians (13 women; mean [SD] age, 33.2 [6.1] years) who completed a simulation exercise involving 4 patient cases (mean [SD] completion time, 34:43 [11:41] minutes) recorded a total of 14 hours and 27 minutes of EHR activity. All physician participants experienced physiological fatigue at least once during the exercise, and 20 of 25 participants (80%) experienced physiological fatigue within the first 22 minutes of EHR use. Physicians who experienced EHR-related fatigue in 1 patient case were less efficient in the subsequent patient case, as demonstrated by longer task completion times (r = −0.521; P = .007), higher numbers of mouse clicks (r = −0.562; P = .003), and more EHR screen visits (r = −0.486; P = .01).
Conclusions and Relevance This study reports high rates of fatigue among ICU physicians during short periods of EHR simulation, which were negatively associated with EHR efficiency and included a carryover association across patient cases. More research is needed to investigate the underlying causes of EHR-associated fatigue, to support user-centered EHR design, and to inform safe EHR use policies and guidelines.
