JMIR Publications

ABSTRACT

Background:

Telehealth, mobile health and other technologies are reshaping the delivery of health care, yet barriers related to workflow and possible provider fatigue suggest that a thorough evaluation is needed for quality and process improvement.

Objective:

This scoping review addresses the overarching question: “What is technology-based fatigue and what are its consequences for providers?”

Methods:

A six-stage scoping review of 12 literature databases, from years 2000-20, focused on technology, health care and fatigue. Technologies were inclusive of synchronous video, telephone, informatics systems, asynchronous wearable sensors, and mobile health devices for health care, in four concept areas related to provider experience: 1) behavioral, cognitive, emotional and physical impact; 2) workplace at the individual, clinic, hospital and system/organizational levels; 3) well-being, burnout and stress; and 4) perceptions regarding technology.

Results:

Out of 4,221 potential literature references, 202 were duplicates, and the title and abstract of 3,837 were reviewed. Full text review of 182 revealed 12 that met full inclusion criteria during the years 2009-20. The data suggest an association between technology and fatigue, particularly related to regular video and electronic health record use. Studies assessed behavioral (8; 66.7%), emotional (4; 33.3%), cognitive (7; 58.7%), and physical (4; 33.3%) impact of workflow, at levels of the individual (11; 91.7% clinic (8; 66.7%), hospital (6; 50.0%), and system/organizational (6; 50.0%) levels; only 3 included all levels. Most health care professionals were those with medical degrees (M.D.) (8 or 66.7% psychiatrist; 2 or 16.7% radiologists); and others (4; 33.3%). All studies were based in the United States. Few studies discuss the physical environment, occupational health approaches, mobile, telework, Lean, human factor and user design approaches to workflow.

Conclusions:

The Quadruple Aim considers provider satisfaction; longitudinal technology implementation research to further population-centered health; increase service delivery effectiveness and reduce provider workload burden, fatigue and burnout. The quadruple aim considers how to support providers as whole individuals and teams, in addition to patient-centered care. Implementation research related to technology can make service delivery more effective and potentially reduce provider workload burden, fatigue and burnout. A multi-level approach with objective measures for clinical, human factor, training/professional development and administrative workflow is suggested. Clinical Trial: N/A