A study published this week in the Journal of the American Medical Informatics Association found that policy experts underestimated the impact of widespread electronic health record use on clinician burnout at the time of the HITECH Act’s passage in 2009.
The retrospective look examined the discussions at the AMIA’s 2009 Annual Health Policy Meeting, which focused on the unanticipated consequences that could occur with the large-scale, national implementation of health IT – especially EHRs – following the HITECH Act.
That policy meeting included many fellows from the American College of Medical Informatics, which met in the winter of 2020 to discuss those 2009 predictions (among other issues).
“The collective opinion of the ACMI fellows participating in this session was that, while many consequences of the HITECH act were foreseen in 2009, the magnitude of the current burnout crisis largely was not,” wrote the JAMIA paper authors.
WHY IT MATTERS
Clinician burnout rates have significantly increased since the federal government’s investment of $36 billion over a decade toward widespread EHR adoption and implementation, with EHRs frequently listed as a significant contributor to burnout.
In 2009, participants at the AMIA Policy Meeting developed 17 predictions for the consequences of widespread EHR implementation and 15 recommendations for ameliorating those effects.
With the benefit of hindsight, the ACMI fellows in 2020 found that some of those concerns were overblown.
Fears around false positives from abuse and harm algorithms, patient harm due to alert dependence, and patient and provider identity theft were widely classified as “Chicken Little” – in other words, not borne out by evidence.
On the other hand, many 2020 fellows labeled concerns around decreased data quality from cut/paste behaviors, forced workarounds due to EHR limitations, increase in documentation and reporting requirements, and clinician cognitive load as “much worse than we expected.”
The 2020 participants also pointed to two unanticipated HIT outcomes over the past decade: increasing monopoly of EHR vendors and minimal improvement in user experience.
“Another observation is that, even though scores of informatics research projects have developed potential approaches to mitigate these problems, too few of those have been translated into real-world solutions,” noted the paper authors.
THE LARGER TREND
As the authors point out, much research has been done exploring potential solutions to the clinician burnout crisis.
A 2019 Mayo Clinic study, perhaps unsurprisingly, linked EHR usability with clinician burnout, prompting a statement from AMA officials. A 2021 study found that women and critical care physicians reported the highest levels.
But it’s not only EHRs: Nurses reporting burnout frequently cited a chaotic work environment, time-consuming bureaucratic tasks and a lack of effective teamwork as significant factors.
ON THE RECORD
“Based on decades of research in the area of EHRs, there were reasons for the informatics community to be concerned about potential adverse consequences of rapid adoption of EHRs.
“Although concerns about EHR usability, data overload, and alert fatigue were identified at the Policy Meeting, the magnitude of the combined burdens placed on clinician users and the resultant burnout was significantly underestimated,” wrote the JAMIA researchers.