Mosquera Matthew J, Ward Heather Burrell, Holland Christopher, Boland Robert, Torous John
Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, USA.
Digital Health Department, Massachusetts General Hospital, USA.
BJPsych Open. 2021 Sep 21;7(5):e174. doi: 10.1192/bjo.2021.993.
Electronic health records (EHRs) are a significant contributor to physicians' low satisfaction, reduced engagement and increased burnout. Yet the majority of evidence around EHR and physician harms is based on self-reported screen time, which may both over- and underreport actual exposure.
The purpose of this study was to examine how objective EHR use correlates with physician well-being and to develop preliminary recommendations for well-being-based EHR interventions.
Prior to the onset of COVID-19, psychiatry residents and attending physicians working in an out-patient clinic at an academic medical centre provided consent for access to EHR-usage logs and completed a well-being assessment made up of three scales: the Maslach Burnout Inventory, the Urecht Work Engagement Scale and the Professional Quality of Life Measure. Survey responses and objective EHR data were analysed with descriptive statistics.
Responses were obtained from 20 psychiatry residents (total eligible residents n = 27; 74% participation) and 16 clinical faculty members (total eligible faculty n = 24; 67% participation) with an overall response rate of 71% (total eligible residents and faculty n = 51 and total residents and faculty who completed survey n = 36). Moderate correlations for multiple well-being domains emerged in analysis for all participants, especially around the time spent per note and patient visits closed the same day.
EHR-usage logs represent an objective tool in the evaluation and enhancement of physician well-being. Results from our pilot study suggest that metrics for note writing efficiency and closing patient visits the same day are associated with physician well-being. These metrics will be important to study in ongoing efforts involving well-being-based EHR interventions.
电子健康记录（EHRs）是导致医生满意度低、工作投入度降低和职业倦怠加剧的一个重要因素。然而，关于电子健康记录与医生伤害的大多数证据是基于自我报告的屏幕使用时间，这可能会高估或低估实际暴露情况。
本研究的目的是探讨客观的电子健康记录使用情况与医生幸福感之间的关联，并为基于幸福感的电子健康记录干预措施制定初步建议。
在2019年冠状病毒病（COVID-19）爆发之前，在一家学术医疗中心的门诊工作的精神科住院医师和主治医师同意提供电子健康记录使用日志，并完成了一项由三个量表组成的幸福感评估：马氏职业倦怠量表、乌得勒支工作投入量表和职业生活质量量表。使用描述性统计分析调查回复和客观的电子健康记录数据。
共获得20名精神科住院医师（ eligible residents n = 27；参与率74%）和16名临床教员（ eligible faculty n = 24；参与率67%）的回复，总体回复率为71%（ eligible residents and faculty n = 51，完成调查的residents and faculty n = 36）。在对所有参与者的分析中，多个幸福感领域出现了中度相关性，特别是在每份记录所花费的时间以及当天完成的患者就诊方面。
电子健康记录使用日志是评估和提高医生幸福感的一种客观工具。我们的试点研究结果表明，记录书写效率和当天完成患者就诊的指标与医生幸福感相关。这些指标对于正在进行的基于幸福感的电子健康记录干预措施的研究非常重要。
