Friday, November 15, 2019

In addition to it being time for patients to refuse use of EHR's in their care, is it time for clinicians to refuse forced use of same? - "Association Between Perceived Electronic Health Record Usability and Professional Burnout Among US Physicians"

At my Nov. 12, 2019 post "Google’s ‘Project Nightingale’ Secretly Gathers Personal Health Data on Millions of Americans - Time to Refuse Use Of EMR's In Your Healthcare?" ( on a massive clinical data project by Google and Ascension Health, I wrote:

... I believe invasive healthcare data trafficking projects like this, with potential for massive abuses, provide reasonable justification for patients to REFUSE the use of EHR's in their care.  Paper works just fine.  In fact, when the IT goes down, it's what hospitals and doctors go right back to, and the PR always claims that "patient care was not compromised."

Yale's Dr. Edward Melnick, assistant professor of emergency medicine and director of the Clinical Informatics Fellowship at Yale (I am Yale FW '94 after completing my postdoctoral fellowship in Yale's Center for Medical Informatics 1992-1994) authored an article further supporting the contention I've been expressing for many years, as have many others.  My belief is that commercial EMR's have become so complex and overwhelming that they actually impair the well-being of clinicians, and thus the very practice of medicine:

The Association Between Perceived Electronic Health Record Usability and Professional Burnout Among US Physicians
Mayo Clinic Proceedings
Edward R. Melnick, MD, et al.


To describe and benchmark physician-perceived electronic health record (EHR) usability as defined by a standardized metric of technology usability and evaluate the association with professional burnout among physicians.

Participants and Methods
This cross-sectional survey of US physicians from all specialty disciplines was conducted between October 12, 2017, and March 15, 2018, using the American Medical Association Physician Masterfile. Among the 30,456 invited physicians, 5197 (17.1%) completed surveys. A random 25% (n=1250) of respondents in the primary survey received a subsurvey evaluating EHR usability, and 870 (69.6%) completed it. EHR usability was assessed using the System Usability Scale (SUS; range 0-100). SUS scores were normalized to percentile rankings across more than 1300 previous studies from other industries. Burnout was measured using the Maslach Burnout Inventory.

Mean ± SD SUS score was 45.9±21.9. A score of 45.9 is in the bottom 9% of scores across previous studies and categorized in the “not acceptable” range or with a grade of F. On multivariate analysis adjusting for age, sex, medical specialty, practice setting, hours worked, and number of nights on call weekly, physician-rated EHR usability was independently associated with the odds of burnout with each 1 point more favorable SUS score associated with a 3% lower odds of burnout (odds ratio, 0.97; 95% CI, 0.97-0.98; P<.001).

The usability of current EHR systems received a grade of F by physician users when evaluated using a standardized metric of technology usability. A strong dose-response relationship between EHR usability and the odds of burnout was observed.

I have two observations:

1.  My January 31, 2018 Healthcare Renewal blog post "The inevitable downgrading of burdensome, destructive EHRs back to paper & document imaging" at, in which I opined that the downgrading of the clinician-facing components of EHRs was essential and inevitable, is increasingly supported by empirical research. 

Research such as this further invalidates marketing-driven  industry narratives about the benefits of today's commercial health IT, which is often bad health IT:

Bad Health IT ("BHIT") is defined as IT that is ill-suited to purpose, hard to use, unreliable, loses data or provides incorrect data, is difficult and/or prohibitively expensive to customize to the needs of different medical specialists and subspecialists, causes cognitive overload, slows rather than facilitates users, lacks appropriate alerts, creates the need for hypervigilance (i.e., towards avoiding IT-related mishaps) that increases stress, is lacking in security, compromises patient privacy, lacks evidentiary soundness, or otherwise demonstrates suboptimal design and/or implementation. (S. Silverstein/J. Patrick, 2012,


2.  In addition to patients having increasingly good reasons to refuse the use of EHRs in their care, clinicians have increasingly good reasons to boycott the forced use of these systems as well. 

In that statement I am not even accounting for EHR malfunctions that lead to patient harm and clinician liability.

-- SS

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