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You have learned the benefits of Health Information Exchange. The Electronic Medical Record (EMR) is one of the basic structures in order to exchange information among different departments/organizations.
Recently, there are many reports stating that EMR is one of top leading causes of physician burnout. The article by Muhiyaddin R, et al. provided evidence of this issue.
What do you think about this finding? Have you ever heard any complaints from health officers (or yourself) on using EMR? Any suggestions to avoid or reduce this problem.
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According to the article by Muhiyaddin R, et al., six general findings revealed real-life scenarios faced by physicians who experience challenges using EMRs in healthcare settings. Although the article did not mention whether EMRs are recorded in real time, the consequences that contribute to physician burnout are equally affecting such as poor quality of care, career dissatisfaction, poor system design, heavy workload/overtime, and alert fatigue.
I had a conversation with a physician working in a private healthcare setting and he explained the situation of the EMR system at his workplace. Since the EMR system requires real-time data entry, it is quite challenging for physicians to manage both EMR recording and patient consultations at the same time. This negatively impacts the quality of care, as the physician must record patient health conditions, history, notes, and clinical findings in the database during the consultation itself. This creates stress for the physician, who struggles to focus fully on the patient while managing database entry.
Moreover, physicians must complete EMR tasks during the consultation in order for other departments (such as nursing, laboratory, or pharmacy) to proceed with the next steps such as blood tests, medications, or follow-up appointments. The system does not allow these steps to move forward unless the physician completes the record. This increases workload and fatigue in addition to consultation duties, and in the long run, may harm both patient-doctor relationships and the quality of care.To reduce such negative consequences:
• The EMR system should be designed with a user-friendly approach, making it less complicated and more time-saving. It should prioritize key data variables and remove unnecessary information. This requires careful planning and involvement of IT and technical experts during the design phase.
• Advocacy and pilot testing should include a proper feedback mechanism so users can share practical, and meaningful input. IT and technical expert teams should act on this feedback to refine and adjust the EMR before full implementation. Feedback without action is ineffective, as EMR systems cannot succeed through a top-down approach alone. All healthcare providers should be actively involved during advocacy and piloting.
• If EMRs are implemented, consultation times should be adjusted in the initial phase,, to allow physicians to become familiar with the system. For example, if physicians previously made consultation with 20 patients per day, the number should be reduced/adjusted to ensure that both consultation quality and EMR recording can be managed without stress. After the initial phase, the system should be re-evaluated by physicians, who should provide feedback on whether the adjustment should continue. In addition, evaluations should be conducted periodically to improve the system over time.
• The EMR system should be flexible by categorizing data into what must be recorded in real time and what can be entered later. This would reduce overtime and help address alert fatigue.-
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Dear Ma Wah,
Thanks for your comprehensive and excellent response.
During my work in MSF, we, MD, had to fill up the FUCHIA forms which take around 3 to 5 minutes by hands on paper excluding the patient consultation and examination time (which altogether last around 15 to 30 mins per patients). However, the MD did not fill the EHR to system and there were data assistants who filled up the FUCHIA Form into the EHR system. The MD used the offline-paper-based FUCHIA files only. I could read other MD handwritings as well as mine to go through the medical records of patients without the stree caused by the EHR in the paper.
As in Myanmar, offline EHR with help of data assistant might be solution for physicians’ burnout related to EHR. -
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I agree with the review that EMRs can cause physician burnout. It aligns with my experience from working with different EMRs in different hospitals, where it clearly shows that design and user-friendliness are very important. Some hospital EMRs cause me frustration when they require too many windows, run too slowly, or force me to go back and forth among various clinical data.
However, I think physician burnout originates more from the heavy nature and environment of clinical work itself. For example, long hours, high patient loads, and pressure to avoid mistakes. EMRs don’t directly create this stress, but they amplify it. When physicians are already overloaded, poorly designed EMRs can add more frustration and lead to heavier burnout.
So, apart from tackling the workload itself, EMRs can still be valuable tools. They should reduce duplication and provide a fast, smooth workflow. Involving health professionals directly in the design process would make EMRs more practical and user-friendly. I also strongly agree that using scribes, voice-over/voice-to-text technology can help with physician routines. In addition, supporting staff who are efficient with EMRs can also help reduce the workload.
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Hi Khun Salin! I like your idea on using voice-over technology. I think it would help physicians’ routines saving time to some extent.
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Thank you for the comment ka. I saw physicians in the U.S. using it in their OPDs. In Thailand, tech start-ups are now developing AI software that can record conversations between doctors and patients and automatically summarize them into HIS/EMR systems, such as Prescribe AI. I think further development is still needed to improve transcription accuracy and ensure it aligns with real-time clinical contexts.
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I think this finding of “EMR is one of top leading causes of physician burnout” is country specific and I want to refer as first world’s problem. Because there are thousands of other reasons which cause physician burnout rather than EMR in developing countries.
I have heard many concerns from healthcare personnel—ranging from community health workers to senior administrators and clinicians—regarding the use of EMRs. To prevent such issues, the primary purpose of implementing an EMR should be to address existing problems rather than create new ones. Every workflow has its own pain points, and the EMR must provide solutions to these challenges in order to encourage adoption. I refer to this as a “working incentive” for using EMRs. When healthcare professionals recognize that the system alleviates their major difficulties, they are more likely to view it as a tool that reduces their workload rather than as an added burden.
As highlighted in the paper, poorly designed EMRs place a significant strain on users. This challenge is not unique to EMRs but applies broadly to all software systems. There are, however, many ways to improve user experience. For example, clinicians primarily want to focus on treating patients, but to do so effectively, they require comprehensive and well-organized patient information. EMRs have clear advantages over paper-based systems in this regard, offering features such as patient dashboards, integration of 2D and 3D imaging, chronological record-keeping, and mapping of relationships.
An EMR should go beyond serving as a mere data-recording tool. It must harness the full potential of digital technology to truly support clinical practice and improve healthcare delivery.
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Dear Sayar Aung,
I can read your msg on LINE but my LINE app had some issues to reply anyone. You can reach me @ +959448001552 on viber, whatsapp or zamliankham@gmail.com for the group assignment.
I also agree with you on EMR being the first world’s problem. In developed countries, I heard that so many clinical and laboratory tests are carried out by the physicians to get accurate and comprehensive diagnosis without missing any diseases by laboratory tests or to avoid lawsuit. Probably, the aftermath of these tests in EMR, migth burn out the physicians again which will never happen in resource-limited countries like ours. -
Hi Ko Aung! I agree with your point on the importance of EMR design, it really matters! and yes, EMR should be valuable to clinical practice and clinical decision support system. Therefore, building trust and sense of ownership for the clinicians about EMR would be an essential part of EMR system implementation.
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My opinion about the findings
The study highlights six main causes of EHR-related physician burnout: EHRs’ documentation and related tasks, EHRs’ poor design, excessive workload, overtime, inbox alerts, and alert fatigue. These problems are well-known in practice, but they can vary depending on the features of the application. These burnouts have consequences such as low-quality care, physician dissatisfaction, turnover, mental health issues, increased substance abuse, behavioral problems, and patient dissatisfaction.
I have experience with some of these problems, such as EHRs’ documentation and related tasks, EHRs’ poor design, excessive workload, and overtime.
My experiences
EHRs’ documentation and related tasks – Healthcare professionals often spend more time typing than interacting with patients, which shifts focus away from patient care.
EHRs’ design – Healthcare professionals and the EHR testing team complained about double clips for simple tasks.
Excessive workload and overtime – Although we expect real-time data entry during consultations, application errors and poor internet connections affect the excessive workload and data re-entry in the free time of healthcare professionals.
Suggestions to reduce these problems
To optimize these problems, I think we can improve the following:
– EHR design can use a simpler user interface, fewer clicks for common tasks.
– Alert management can cut down on unnecessary notifications and prioritize important ones.
– Providing training to healthcare professionals to use EHR efficiently and provide responsive IT support to fix errors quickly.
– Policy and working culture should adapt by recognizing EHR-related stress and allowing more flexible schedules. -
According to the article by Muhiyaddin R, et al., the six main problems causing Physicians’ Burnout are EHRs’ documentation and related tasks such as note taking and electronic communication in EHRs, EHRs’ poor design, workload, work overtime, inbox alerts, and alert fatigue.
Yes, I’ve heard similar complaints. Many health officers say that using EMR takes more time than expected, especially when the system is slow or complicated. Some prefer paper records because they feel faster during busy clinic hours. In Myanmar, where internet and electricity can be unstable, EMR use can add several extra stress instead of helping, it create extra workload addition to papar records.
Suggestions might include using offline EHR with simplified user-friendly design (maybe using a lot of drop-down lists), providing training prior to physicians, and hiring data-entry assistants for physicians. -
Yes, I agree with this finding. From my own experience and perspectives from my peers, using EMR can lead to physical and mental burnout while it gives many advantages at the same time.
From EMR user point of view
Poor internet connection – It is very distressing when the connection is down as workflow are disrupted and delayed especially during busy hours.
Eye strains and cervical spondylosis – After using EMR for 2 years in our hospital, most of my friends increased lens power and got neck stiffness, due to too many screens time.
Increase workload – Since we cannot fully adopt EMR system (due to consultants’ nature), we also use paper-based patient’s chart. Therefore, we have double data entry and workload.
EMR design and built-in functions – our EMR system need to be fully online to operate, and it has so many steps just to note progress, order tests and prescriptions. Moreover, some medication interaction alerts are too overwhelming. (e.g. the system notifies even if a patient is prescribed dual anti-platelets)
Dependent steps – if the attending doctor is busy and cannot order a lab test in the system, the nurses cannot proceed with the following steps of drawing the blood and send the blood tube to the lab. Patients’ cares are so much delayed in these scenarios. We even sometimes face patients’ complaints and dissatisfactions due to the delay.From the patient’s point of view
Less patient interaction – as the doctors and nurses are busy in front of the screen with documentation and ordering test/medication, they have less patient exposure time, and this can jeopardize quality of care and patients’ satisfaction.
Missed important clinical signs – doctors can also miss clinical signs due to the burnout. As we are treating the patient not just the disease, more focus should be kept on the patients.Ways to reduce these problems
Increasing the manpower – Since the workload is increase, the manpower should also be increased.
Task-shifting – one of the strategy our hospital used is that they appointed nurses/pharmacist to do the EMR task so that doctors can pay more attention to patient care.
EMR design and functionality – some EMR can cache the data locally and synchronize and upload the stored data when online, this can avoid the delay of tasks when the internet connection is unstable.
EMR design should be more user friendly with few steps.
Data minimization – to avoid redundancy and duplication.
Feedback loops and review the workflow – regular feedback meeting with EMR users and adapt/upgrade the system as necessary. -
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I agree with the study’s conclusion. EMRs were designed to improve efficiency, accuracy, and interoperability, but in practice, they often introduce heavy documentation tasks, complex interfaces, constant alerts, and increased administrative workload. These factors can overwhelm physicians and reduce the time they spend on actual patient care, which is a key source of professional satisfaction.
I have heard many concerns from healthcare professionals that they feel they spend more time typing, documenting things than interacting with patients. User friendly interface is important as this can make simpler and easier for users.
Some solutions could be:
1. Improve system usability: We can simplify EMR interfaces, reduce unnecessary clicks, and make workflows more intuitive and using speech-to-text and natural language processing to reduce manual typing.
2.Delegate non-clinical tasks: We can employ assistants to handle routine documentation as Sir. Zam suggests. Automate repetitive tasks like prescription refills and test result notifications.
3. Training and support: We can provide continuous training so staff can use EMRs more efficiently. Involve physicians in EMR design feedback loops to ensure real-world usability.
4. Policy and organizational support: Allow protected time for documentation within working hours instead of after hours. -
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According to the article, one of the causes of physician burnout and stress is the poor design and difficult use of EHR, and EHRs with high number of functions will likely lead to high stress of physicians. I think these findings support the observations on healthcare IT of Dr. John Halamka (as presented by Dr. Boonchai Kijsanayotin in his lecture), a top-down approach never works. The target end-users of the EHR must be involved in the development of the EHR, including the planning and design stage in order to avoid this problem.
According to our municipal health officer, one of the major difficulties he encountered in using the EMR is that it is time-consuming. The EMR requires many patient details to be entered in the system, especially for patients who are availing our facilities’ service for the first time. To lessen the burden on our healthcare workers during consultation, we decided to assign a different staff who will be in charge of interviewing and entering patient details of the EMR.
Another problem we had with the EMR is that it requires an internet connection. We are currently working in a temporary office because our Rural Health Unit was demolished to make way for the construction of a bigger health facility. During our first few months in the office, we had difficulty using the EMR because of poor signal in the area. Fortunately, free internet was installed soon after as part of the Free Wi-Fi for All program of the Department of Information and Communications Technology (DICT).
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According to the article, physicians are not familiar with EHR and related IT tasks so they feld burden on EHR’s documenntation and workload burden. As they are working for human beings especially unhealthy cohorts, they will have unconsiciously concerns on inbox alerts and feel fatigue on dealing them.
The collegues working with EHR system in my country also felt above symptoms. Some are still reluctant to do documentation, some requests to assign data assistant for data entry etc.
Suggestions to reduce these:
i. prepare the EMR design to be user friendly setting
ii. train medical professionals about the system and advocate about the importance and benefits of eHealth
iii. use AI technology in implementing EMR and reducing workload burden on medical professionals -
I partly agree with the findings from ‘Electronic Health Records and Physician Burnout’. Although electronic records and health information exchanges (HIEs) have many benefits such as improving coordination of care and reducing duplication of tests, these EMRs are also a major contributor to physician burnout.
The main causes include excessive documentation requirements, poor system design, high workload, working overtime to complete record and constant inbox alerts that lead to “alert fatigue.” These issues shift physicians’ focus from patient interaction to screen time which not only reduces job satisfaction but also negatively impacts patient care. Personally, I think some EMRs are time-consuming and sometimes difficult to navigate. The system requires a lot of times for simple tasks.
To reduce this problem, several measures are needed such as improving UI/UX, reducing unnecessary steps/documents, providing comprehensive training and optimizing the alert system.
Actually, I suppose EMRs are valuable tools but without proper design and support, they risk becoming a source of stress and burnout for health professionals. A balanced approach is needed to retain their benefits while minimizing negative impacts on physician well-being. -
1) What do you think about this finding?
Regarding to EHR six main causes of physician burn out, 1) EHRs’ documentation and related tasks, 2) EHRs’ poor design, 3) workload, 4) work overtime, 5) inbox alerts, and 6) alert fatigue.
2) Have you ever heard any complaints from health officers (or yourself) on using EMR?
This is also common in our implementation The main reason is poor design, interactive functions like auto filling, coding instead of filling long text, lack of trainees, continuous maintenance and system improvement.
3) Any suggestions to avoid or reduce this problem.
The resolving options are firstly EHR app design fixing upgrading to be user friendly and assisting interactive auto generated function. Then, conducting training for user and gathering feedback and continuous improvement before releasing the app. -
Yes, I agree with the finding of Muhiyaddin et al. (2022) that EMR/EHR is one of the top causes of physician burnout. Many health officers say EMR takes too much time and creates stress. The common problems are heavy documentation, poor system design, and too many alerts. Doctors often need to work overtime, sometimes even at home, just to finish their records. This makes them feel tired, lose balance between work and personal life, and sometimes even lose interest in their career.
From my experience working with clinics in the ethnic health organizations’ areas in Myanmar, I have also heard similar complaints. Many health workers there said they prefer simple paper records, because EMR systems are slow, require internet, and are not aligned with local context and workflow. They felt that instead of helping them save time, EMR made them spend more hours on data entry and less time with patients. This reduced their motivation and sometimes caused frustration in the team.
To reduce this problem,
1. Improve EMR design – make it simple, fast, and align with workflows.
2. Give proper training – so health workers know how to use it easily.
3. Reduce data amount – keep only the important ones.
4. Provide support staff – to help with data entry, so doctors can focus on patients.
5. Encourage balance – limit after-hours work with EMR and allow offline options in low-resource areas. -
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