EHRs negatively affect wellbeing of healthcare teams, study finds

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Electronic health records are the dominant form of communication among healthcare teams, but while a JAMA Network Open study found that they do facilitate straightforward, task-related communication, they limit "rich and social" communication.

In other words, EHRs have a negative effect on team function and team wellbeing, according to authors.

The technology shifts attention away from the human needs of the care team, they said. Interventions to cultivate interpersonal interactions and team function are necessary to complement the efficiency benefits of health information technology.

This is relevant, because not only do team function and communication play a role in clinician wellbeing, but these dimensions of organizational behavior also affect institutions' financial, clinical and operational performance. 

The ways it has altered care delivery are also major sources of physician distress, increasing administrative tasks, increasing time spent on work outside of scheduled hours and decreasing physician time for patient care, the report determined. 

A previous study by several of the same authors indicated that EHR requirements often take precedence over other physician core competencies, disrupting professional conduct and causing distress to physicians and team members.

Authors framed their research around the relationship-centered organization (RCO) model, which posits that relationships are central to the wellbeing of healthcare organizations.

WHAT'S THE IMPACT?

Several physicians were interviewed for the paper, and, while they agreed that the EHR has improved lean and task-related communication – good for simple, uncomplicated tasks – they perceived that the EHR negatively impacts team function by amplifying disagreement and introducing conflict.

The results suggest that the EHR supports looser forms of interprofessional work, such as networking and coordination, at the expense of more intense collaboration and teamwork.

Another major finding centered on the EHR and individual physician wellbeing. Most studies investigating the association between team function and physician wellbeing have focused on the role that team function may play in physician wellbeing, the authors said. This study explores a reverse connection, suggesting that fostering physician wellbeing may be beneficial for team function, and therefore may minimize unprofessional behaviors instigated by physician distress. This represents yet another rationale for system approaches to address burnout in healthcare.

The results, authors said, confirm past findings around the importance of face-to-face interaction in supporting physician wellbeing. Direct interaction may mediate EHR-related physician distress and enable physicians to build relationships and address conflict, they said.

THE LARGER TREND

The new findings track with a 2021 study showing EHR-integrated patient-generated health data may create burdens for clinicians, leading to burnout.

In particular, researchers from Northwestern University found that technostress, time pressure and workflow-related issues need to be addressed to accelerate the integration of patient-generated health data into clinical care.

Based on surveys of more than 20,000 U.S.-based physicians, data published in November showed overall burnout rates at 49% over a three-year window. 

Burnout was 45% in 2019 and declined through the year. There was a brief rise in early 2020 followed by a decrease during the early phases of the pandemic (40%-45%). Burnout increased toward the end of 2020 (50%), generally worsened throughout 2021, and showed a steep rise to the highest levels ever recorded by the fourth quarter of 2021 – about 60%.

But while burnout rates increased, the increase was lower if clinicians felt a sense of teamwork or being valued. In the fourth quarter of 2021, for example, burnout was 37% when feeling valued, compared with 69% when not.
 

Twitter: @JELagasse
Email the writer: Jeff.Lagasse@himssmedia.com