Using technology is a major part of most health care workers’ routines. | Reuters/Agustin Marcarian
The rising use of technology in health care settings is a mixed bag.
On one hand, technology-based innovations like electronic health records — now present in about 90% of all U.S. medical practices — mean faster access to patient files and easier coordination of care across practitioners and settings.
On the other hand, increased application of technology in medical settings can be a problem for those expected to use it. For example, non-user-friendly interfaces and frequent updates may frustrate health care workers. And electronic records can place large demands on practitioners’ time: Outpatient physicians now spend twice as much time on electronic records as they do with patients.
This double-edged sword of health care technology is a source of deep interest to Mohsen Bayati, an associate professor of operations, information, and technology at Stanford Graduate School of Business, and Daniel Tawfik, an instructor of pediatrics at Stanford School of Medicine.
As Bayati says, “Technology innovations offer many benefits, such as enabling understanding of digital ‘signatures’ of patients’ health to determine their care. But the same systems may lead to emotional exhaustion, or burnout, among providers, which increases opportunities for human error.”
Tawfik agrees: “The new systems add clerical and administrative roles they might not have had previously.” Moreover, burnout affects hundreds of thousands of health care workers and costs the U.S. health care system up to $6 billion annually.
To understand the relationship between technology-related frustration and burnout, Tawfik, Bayati, and other collaborators from Stanford (Amrita Sinha, a pediatrics fellow; Tait Shanafelt, a professor of hematology; and Jochen Profit, an associate professor of pediatrics) and Duke University analyzed data from a large survey of health care workers. In a recently published paper, they found that about a third of health care workers reported frustration with technology, and this frustration contributes significantly to burnout.
Large-Scale Survey
The researchers analyzed data from an email survey administered in 2015 to over 15,000 health care workers at 31 Michigan hospitals. Nurse was the most common (28%) occupation represented, followed by technician (12%) and administrative support (12%).
The survey included questions that measure “work-life integration” and emotional exhaustion, or burnout. “The integration questions got at how people resolve conflicts between work and life — such as coming home late or missing meals,” Tawfik says.
Here, the question of interest was: “During the past week, how often did you feel frustrated with technology?” The survey didn’t define “technology” for respondents, letting them interpret it for themselves.
“It could have included anything like looking up lab results in electronic health records or inputting vitals or other assessments or orders into the records,” Tawfik says. “It’s a very prominent part of the day for health care workers.”
The researchers used a regression analysis combined with techniques from machine learning to understand the independent effect of each integration factor on emotional exhaustion for the workers surveyed, after controlling for a large number of potential confounding factors.
A Universal Concern
Frustration with technology, the study found, is common among health care workers and a large correlate of emotional exhaustion.
One-third of all respondents reported feeling frustrated with technology at least three days per week. While difficulty sleeping was the strongest contributor to burnout, frustration with technology was second: For every 10 points (on a 100-point scale) a respondent said they felt more frustrated by technology, their burnout score was 1.2 points higher (also on a 100-point scale). “That’s a strong correlation,” Tawfik says. “And it’s independent of all the other indicators of workload and work-life integration.”
The link between frustration with technology and burnout cuts across all types of health care workers. “About half of our respondents are in direct clinical care — doctors, nurses, respiratory therapists — and half are in indirect care, like administrative support and custodians,” Tawfik says. “The relationships we found were nearly identical across groups, independent of the actual role. It just seems to be a human experience people are having.”
Moreover, an analysis of survey results across different health care settings (specific physician groups, clinics, billing departments, others) suggested technology frustration is present across all sectors, but varies by individual, as Tawfik points out: “We examined more than 1,000 different work settings and found that in each setting there were some individuals who were frustrated and some who weren’t. So it was about an interaction between the individual and the technology.”
Bayati and Tawfik are quick to note that the research here is observational and is a first step toward establishing a potentially causal relationship. Nonetheless, they say, the findings have important implications for the health care domain.
Battling Burnout
One practical, positive implication of the research is that reducing burnout doesn’t require a complete overhaul of technology in place, especially because many workers are comfortable with current systems, as suggested above.
So it’s likely about recognizing what individual workers require. “Changing the technology completely would be expensive and probably cause even more frustration,” Tawfik says. “People who are frustrated may just need a little bit more training or some tips on how to be more efficient. Or maybe they need to realign their expectations of what the technology can provide.”
Bayati notes that “more effort is needed to minimize the highly repeated clerical tasks that current health care technologies require, potentially using AI to automate these simple tasks. Government incentives, as part of the Affordable Care Act, facilitated adoption of electronic health records. The same approach could be applied to nudge key stakeholders to reduce frustration with health care technology.”
Strategies for solutions will be informed by the next phase of research into the technology-burnout connection. “This was a broad-strokes sort of study,” Tawfik says. “The next couple of questions concern what is it about the technology or interaction with technology that’s predictive of burnout. Once we understand those mechanisms better, we can work to develop interventions that help individuals interact with technology more effectively.”
In fact, Tawfik is currently studying factors that may contribute to frustration related to electronic health records, including the amount of time people spend on such records and how that impacts their overall efficiency with patient care and, in turn, their burnout levels. He’s also looking at how workers are actually writing notes: “Are they typing them? Dictating? Copying-pasting? What we find may help us develop better note-writing practices that can help individuals as well.”
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