Summary

The electronic health record may be a significant component causing burnout in orthopaedic surgeons.

Abstract

Introduction

Physician burnout is a serious concern in the United States, with reported prevalence of 40 to 50%. It is associated with an increased risk of major medical errors, lower quality care, higher costs, and decreased physician satisfaction. Since the use of electronic health records (EHR) has become commonplace, many physicians now spend as much time on the computer as they do with patients. Physicians using EHRs have higher rates of burnout. Time spent after hours on EHR and volume of inbox messages were shown to be related to higher burnout rates among primary care physicians. While orthopaedic surgery residents and attendings are among those with highest rates of burnout, there has been no investigation on the effect the EHR has on burnout within this specialty. The aim of this study was to determine the amount of time spent on the EHR compared to patient interaction in a busy orthopaedic outpatient clinic. It was hypothesized that the surgeon spends at least as much time on the EHR as they do interacting with patients on a clinic day.

Methods

A busy orthopaedic surgeon at University of Pittsburgh Medical Center (UPMC) was followed on two clinic days to determine the amount of time spent on Epic EHR compared to face-to-face interaction with patients. A research assistant recorded total time spent dictating notes or writing orders (EHR time) and total time on loading screens during which no actions could be completed (loading time). Time spent responding to inbox messages was recorded after clinic was completed.

Results

On both clinic days, the surgeon had 60-65 patients scheduled from 7am to 4pm. On day 1 the surgeon spent 4 hours and 46 minutes using the EHR, 23 minutes of which was loading time. This accounted for 53.0% of clinic time. The surgeon spent 1 hour after clinic responding to inbox messages (11.1% of clinic time). In total, 64.1% of the surgeon’s clinic day was spent on the computer. On day 2 the surgeon spent 4 hours and 10 on the EHR, 15 minutes of which was loading time. This comprised 46.3% of clinic time. The surgeon spent 30 minutes after hours responding to inbox messages (5.6% of clinic time), totaling 51.9% of the day spent on the computer.

Discussion

The current study found that approximately half of the surgeon’s clinic time was spent entering information into the EHR or on loading screens. When accounting for time spent after hours responding to inbox messages, computer time surpassed face-to-face patient interaction. Given the requirements for extensive EHR documentation, orthopaedic surgeons are at high risk for burnout. Unfortunately, no easy solution exists. The simplest and most effective solution would come from more user-friendly EHRs with less documentation required for each physician. This would allow more patient interaction and less time wasted recording information simply for reimbursement purposes. However, since few EHRs control the market, there is little incentive for change. Other potential solutions include the use of scribes, advanced care team models, limitations on work hours, and mindfulness training for residents and faculty. A multifactorial approach is likely the only way to make a significant dent in the widespread pandemic of physician burnout.

Clinical Significance: Physician burnout due to the electronic health record is widespread across all specialties, and orthopaedic surgery is no exception. While numerous approaches to improve the current system have been proposed, the best solution likely involves a multifactorial approach.