Minimizing Stress, Maximizing Success of Physician's Use of Health Information

Physician stress and burnout impact physician health, professional performance, and the quality of care they provide. Adverse workflow, little autonomy, and unfavorable organizational culture are strongly associated with low physician satisfaction and high stress. Expanding use of health information and communications technologies (HICT) increasingly enables practitioners to access electronic health records (EHRs) from virtually anywhere at any time. In other industries, it is well documented that the frequent use of information and communication technologies increases the risk of prolonged stress and depression. However, little is known about the impact of HICT on provider health.

This project identified the features of HICT that are associated with clinician stress and burnout and the coping strategies used by providers in response. By learning more about stresses brought on by HICT, researchers sought to support the benefits of HICT on patient quality and cost of care, while assuring the general wellness of its users.

The specific aims of this project were as follows:

• Identify and characterize points of stress on practitioners associated with the use of advancing HICT. 
• Identify the coping strategies practitioners use to effectively manage the stress associated with the use of HICT. 
• Determine the associations between stress on practitioners and a) the use of information and communications technologies, and b) the use of coping strategies to effectively manage stress associated with the use of HICT. 

Researchers conducted focus groups with 41 physicians at three institutions using three different EHRs to identify the HICT-related factors associated with stress and burnout. The results of the focus groups then informed the development of a survey that was administered to 450 providers including physicians, nurse practitioners, and physician assistants. Providers overwhelmingly agreed that HICT is a significant source of their work stress. The most prevalent reported HICT challenges were excessive data entry, inaccessible information from multiple institutions, notes geared toward billing instead of patient care, lack of work-life balance, poor posture, and physical pain. The most common reported coping strategies included exercise, talking with others, and setting work boundaries.

Specific factors such as information overload, fear of missing important data, and notes geared toward billing could be targets for efforts to reduce stress and burnout. Providers reported that coping strategies such as good self-care, exercise, and resiliency training help somewhat, but HICT stress is having an overall negative impact on provider job satisfaction, burnout, and work-life balance. Researchers hypothesize that developing and implementing a “HICT stress” scale to measure and monitor HICT related stress could be useful to providers.