Accepted for/Published in: Journal of Medical Internet Research
Date Submitted: Aug 12, 2020
Date Accepted: Dec 7, 2020
Date Submitted to PubMed: Dec 8, 2020
Perceived electronic health record usability as a predictor of task load and burnout among US physicians: A mediation analysis
ABSTRACT
Background:
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:
The objective of our study was to determine the relationship between physician perceived EHR usability and workload in real practice settings 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 sub-survey 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 NASA-Task Load Index (TLX; range 0-400). Burnout was measured using the Maslach Burnout Inventory.
Results:
The mean scores were SUS 46.1 (SD 46.1) and PTL 262.5 (SD 71.7). 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 more favorable SUS score associated with a 0.57 point lower composite PTL score (p < 0.001). After controlling for the same personal and professional characteristics in a separate multivariable analysis, quintiles of both SUS and PTL demonstrated a dose-response relationship with burnout.
Conclusions:
A dose-response relationship 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. Improving EHR usability while decreasing task load has the potential to allow practicing physicians more working memory for medical decision-making and patient communication. Clinical Trial: N/A
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