The Association Between Perceived Electronic Health Record Usability and Professional Burnout Among US Physicians

TLDR

The study aims to benchmark physician‑perceived EHR usability using a standardized metric and assess its association with professional burnout. A cross‑sectional survey of 30,456 US physicians, with a 25% subsample completing a System Usability Scale (SUS) assessment and Maslach Burnout Inventory, was used to evaluate EHR usability and burnout. Among 5,197 respondents, the mean SUS score was 45.9 (bottom 9%), and each 1‑point increase in SUS was associated with a 3% lower odds of burnout, revealing a strong dose‑response relationship.

Abstract

ObjectiveTo 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 MethodsThis 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.ResultsMean ± 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).ConclusionThe 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.