Docs who spend less time in the EHR are more likely to leave their jobs

By Kat Jercich for Healthcare IT News

A study published in the Journal of the American Medical Association Network Open this week found an association with electronic health record usage patterns and physician turnover.

But contrary to researchers’ hypothesis, their analysis found that less time in the EHR – especially inbox management – was associated with provider departure.

“Low demand for a physician’s service, time on the EHR and inbox, and rates of teamwork on orders may very well be lead indicators for physicians preparing to leave practice,” said the researchers.


The study, led by researchers from the Yale School of Medicine, sought to examine the links between physician productivity, EHR use and physician turnover.

They did so by retrospectively examining vendor-derived EHR use data from 314 nonteaching ambulatory physicians from a New England practice network.

Given, as previous studies have shown, that EHR use has been linked to provider burnout, the research team said it expected those who spent more time in the EHR to have higher turnover levels.

Instead they found, “The direction of the association between these time-based EHR use metrics and physician departure was opposite of the hypothesized direction.”

Researchers proposed a number of explanations for this: Perhaps physicians who are in less demand or winding down their practice may have less EHR work to do, or may be able to complete more of their EHR work during scheduled clinical hours.

“This could falsely decrease their EHR use time regardless of their efficiency or proficiency with EHR-related work,” they wrote.

Alternatively, physicians who leave their practice could be more proficient with the EHR – and possibly spend less time in it – and therefore more marketable to move to a new position, they theorized.

Lower rates of teamwork on order entry were also associated with physician departure.

“Taken together, these findings suggest that a refined, prospective model of vendor-derived EHR data could help to identify physicians at high risk of departure who might benefit from targeted team-based care interventions,” the study read.

“The counterintuitive direction of the association of time spent on EHR activities and physician departure warrants further investigation,” it continued, especially concerning the link between burnout and departure.

“Standardizing vendor-derived data definitions (across and within vendor products) with better integration of clinical schedules could improve data validity and reliability,” it added.


As noted by the researchers in the study in JAMA Network Open, providers have frequently linked EHR usability (or lack thereof) to clinician burnout.

Some EHR vendors have responded by redesigning their user interfaces in attempts to work toward a more intuitive workflow amidst the additional stress of the COVID-19 pandemic.

But tech may be a tool to address stress too: Nurses in the thick of things say EHR-embedded automation and artificial intelligence can help them accomplish patient care more seamlessly.


“With greater data validity and reliability, future models could prospectively identify physicians at high risk of departure who would benefit from targeted interventions to improve retention,” said the researchers.

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