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Electronic health record associated stress: A survey study of adult congenital heart disease specialists

Darcy N. Marckini1, Bennett P. Samuel1, Jessica L. Parker2, Stephen C. Cook1,3

1 Congenital Heart Center, Spectrum Health Helen DeVos Children’s Hospital, Grand Rapids, Michigan
2 Spectrum Health Office of Research, Grand Rapids, Michigan
3 College of Human Medicine, Michigan State University, Grand Rapids, Michigan

* Corresponding Author: Stephen C. Cook, MD, Congenital Heart Center, Spectrum Health Helen DeVos Children’s Hospital, 100 Michigan NE (MC248), Grand Rapids, MI 49503. Email: Stephen.Cook@helendevoschildrens. org

Congenital Heart Disease 2019, 14(3), 356-361.


Background: Physician burnout has many undesirable consequences, including nega‐ tive impact on patient care delivery and physician career satisfaction. Electronic health records (EHRs) may exacerbate burnout by increasing physician workload.
Objective: To determine burnout in adult congenital heart disease (ACHD) specialists by assessing stress associated with EHRs.
Design: Electronic survey study of ACHD providers.
Setting: Canada and United States.
Participants: Three hundred eighty‐three ACHD specialists listed on the Adult Congenital Heart Association directory between February and April 2017.
Outcome Measures: Burnout was measured using the Maslach Burnout Inventory (MBI) to understand factors contributing to work life and EHR satisfaction. Chi‐ square and Wilcoxon Rank Sum tests were used for statistical analysis.
Results: Of the 383 invited participants, 110 (28.7%) completed surveys with the majority (n = 88, 80.7%) reporting from an academic medical center. Burnout was defined as high scores on the emotional exhaustion and/or depersonalization MBI subscales. When comparing the 40% (n = 44) that met criteria for burnout with those that did not, there was strong disagreement that a reasonable amount of time is spent on clerical tasks related to direct (P = .0043) or indirect (P = .0004) patient care. There was strong disagreement that EHRs increased efficiency (P = .006) or the patient portal improved patient care (P = .0215). Finally, physicians who met criteria for burnout had lower personal accomplishment scores (P = .0355).
Conclusions: Our results suggest time spent on EHRs creates clerical burden exacer‐ bating ACHD physician burnout. The high levels of emotional exhaustion may de‐ crease quality of ACHD care by directing focus away from physician‐patient interaction. Health care systems must develop best practice for EHR design and im‐ plementation to optimize patient advocacy and care, and decrease physician burnout.


Cite This Article

Marckini, D. N., Samuel, B. P., Parker, J. L., Cook, S. C. (2019). Electronic health record associated stress: A survey study of adult congenital heart disease specialists. Congenital Heart Disease, 14(3), 356–361.

This work is licensed under a Creative Commons Attribution 4.0 International License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
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