The topic of physician burnout has received a lot of attention lately, and understandably so. COVID-19 has added immense pressure and stress to what was already a challenging career. It has contributed to longer shifts, limited resources, and increased risk for frontline workers. But burnout has been impacting healthcare organizations long before COVID-19.
In 2017, 44% of surveyed physicians reported symptoms of burnout, and its costs are detrimental. Physician burnout can impact patient care and increase the risk of medical mistakes. It can also lead to physicians leaving the medical field and, in extreme cases, suicide. In 2018, the AMA estimated that the U.S. economic impact of physician burnout was $4.6 billion per year.
EHRs: a leading cause of physician burnout
There are many causes of physician burnout, such as too many administrative tasks, not having enough time with patients, and working too many hours. But one topic comes up repeatedly in conversations about physician burnout – the increased use of electronic health or medical records (EHR/EMR). In fact, the 2018 Harris Poll conducted by Stanford Medicine found that seven in 10 physicians agree that “EHRs contribute greatly to physician burnout.”
While very effective tools, EHRs are complex applications that can be difficult for users to learn. To make matters more challenging for users, they are subject to frequent updates, upgrades, and changes required for federal compliance. But most importantly, time spent in the EHRs is time spent away from patients. The Harris Poll also found that physicians spend an average of 31 minutes on behalf of each patient, 19 of which are spent in the EHR.
Time spent in the EHR doesn’t just cut into the time physicians spend with their patients; it also means less time spent at home. More than 70% of physicians surveyed in the Harris Poll agree that “using an EHR has increased the total number of hours I work on a daily basis.”
A recent study published by the Journal of the American Medical Informatics Association (JAMIA) identified a direct correlation between time spent on after-hours charting and self-reported burnout among physicians. More specifically, it found that physicians who spent five or fewer hours of weekly after-hours charting were twice as likely to report lower levels of burnout than those who spent six or more. 43% of physicians in the study reported spending six or more hours per week on after-hours charting, indicating that EHR fatigue is a leading cause of physician burnout.
Can better training reduce physician burnout caused by the EHR?
EHR fatigue may be a leading cause of burnout, but there are steps that organizations can take to reduce the negative impact the EHR has on their physicians and improve satisfaction.
Studies show that the quality of training physicians receive has far more impact on their EHR satisfaction than the software itself. In this Becker’s Healthcare podcast featuring Dr. CT Lin, CMIO at UCHealth, he shares that in his experience “20 percent of improving the EHR for a particular clinic or for a particular clinician is technical improvement. 80 percent is training of the end user.” The JAMIA study found that physicians “who agree that their organization has done a great job with EHR implementation, training, and support were also twice as likely to report lower levels of burnout than those who disagreed.”
When looking for ways to reduce physician burnout, improving EHR training and support offers hope. At the end of the day, the focus must be on increasing satisfaction, usability, and proficiency within the EHR.
7 tips for successful EHR training & support
KLAS Research’s Arch Collaborative serves as an expert in guiding EHR training and support efforts for healthcare organizations. Based on their findings and the success our healthcare clients have experienced, we’ve put together 7 tips for successful EHR training & support.
1. Invest in EHR training and onboarding from the start
Don’t cut corners on your initial training program. While ongoing training and support should play a vital role in your overall training strategy, research suggests that the quality of initial EHR education is the single most important factor in determining end-user satisfaction.
The Arch Collaborative recommends asking the following questions to self-assess current training programs:
- Would I enjoy going through our existing training programs?
- Do we expect all new clinicians to go through 7+ hours of initial training?*
- Are our training opportunities in high demand?
*Data indicates that providing at least 7 hours of initial EHR education correlates with higher satisfaction scores. It recommends breaking this training up into blocks to make it most effective.
2. Consider going digital
Does 7+ hours in a classroom sound like too much? Consider switching to a hybrid training model that utilizes digital learning tools. Virtual training provides many benefits. It can make your training strategy more agile, optimizing it for dealing with turnover and scaling for growth. It can also save money on instructor-led classroom training and reduce onboarding time. When Gundersen Health System incorporated uPerform as part of their new hybrid approach to training, they reduced Epic onboarding time by 66%.
“We provide at-the-elbow customization and personalization, which we have found is the most beneficial time spent with clinicians. They have told me many times that this model is so much better than sitting through an eight-hour class.” — Polly Berendes, Advanced Training Consultant at Gundersen Health System
3. Make ongoing training opportunities available
Research also suggests that ongoing EHR training correlates with higher satisfaction scores. The Arch Collaborative recommends about three to five hours per year of ongoing training. Ongoing training and support provide a refresher on infrequent tasks and can help identify areas for improvement. Clinicians who attend ongoing training estimate that it saves them over two hours of time per week in the EHR.
By leveraging uPerform to provide ongoing training opportunities in the workflow, Baylor Scott & White Health (BSW) improved EHR satisfaction among uPerform users.
4. Deliver role-specific training content
Time is of the essence. Nobody wants to sift through information that is not relevant to them. uPerform advocate and Director of IT for UC Health, Kelley Williamson, aptly notes “Burnout is huge in organizations…If a change or an upgrade does happen, our clinicians need to know what those changes are…and whether or not it affects them.” Her observations are consistent with those of the Arch Collaborative, which found that workflow-specific training material correlates with higher EHR satisfaction.
5. Offer users just-in-time support within their workflow
People begin forgetting what they’ve learned as soon as they finish training. Just-in-time learning materials within the workflow allow EHR users to get the help they need when and where they need it most. After implementing uPerform, Derek Harley, Learning and Development System Manager at M Health Fairview says, “I think that is where the future of learning is right now. Giving end-users short bites of content when they need it, in a way that works for them.”
As a bonus, just-in-time support can also reduce time spent searching for help when users do get stuck. Users of uPerform report a 40% reduction in help desk calls and a 15% increase in user efficiency.
6. Make your content more accessible with multiple formats
Give your users training content in the format they prefer. Everyone learns differently, so it is important to offer a variety of training methods to your end users. For digital training, consider tools that allow for the quick creation and delivery of multiple learning formats, such as tip sheets, videos, simulations, etc. Users report that with its content creation tools, uPerform speeds up authoring time across multiple platforms by 50%.
7. Keep it centralized
Make it easier for both your learners and content creators by investing in software that offers centralized content management and distribution across multiple systems. For creators, this means fewer dashboards to manage, expediting the authoring and distribution of content. For users, this means always knowing where to go to find the help they need.
It also adds credibility to the content you share. When discussing the benefits of uPerform for UCHealth, Kelley Williamson emphasizes, “Everything was everywhere for training, and there were many different places that things were being created, so having one source of truth at everybody’s fingertips was very, very important to us.”
Deliver EHR training in the workflow with uPerform
uPerform is a just-in-time training and support platform that allows healthcare organizations to create, manage, and deliver training and support materials to end users when and where they need them most – in the workflow. uPerform works with popular EHRs like Epic, Oracle Cerner®, and Meditech®, as well as enterprise applications like the ERP, HCM, and more, to support clinicians while they work, improving EHR satisfaction and giving time back to patient care.
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