Electronic health records (EHR) are supposed to improve quality. While EHRs certainly are highly useful for information sharing, they may have adverse consequences. One issue may be that EHRs may induce fatigue in physicians and sap their needed energy/concentration away from their primary task: caring for patients.
To test whether EHRs increase physician fatigue and impact efficiency, a paper by Khairat et al. (2020) looked at ICU physician use of EHR. The authors test for fatigue using pupillometry and efficiency, using metrics such as mouse clicks, time, and number of EHR screens needed to complete a task. They find:
All physician participants experienced physiological fatigue at least once during the exercise, and 20 of 25 participants (80%) experienced physiological fatigue within the first 22 minutes of EHR use. Physicians who experienced EHR-related fatigue in 1 patient case were less efficient in the subsequent patient case, as demonstrated by longer task completion times (r = −0.521; P = .007), higher numbers of mouse clicks (r = −0.562; P = .003), and more EHR screen visits (r = −0.486; P = .01).
In short, while EHR are useful, the benefits for mandating additional physician record keeping need to be weighed by the cost of these tasks, which will include not just physician time cost but also its impact on physician fatigue.
Great comments on EHR fatigue. EHRs (or EMRs) were never made to make physician lives easier. EHRs are expensive, do not share data well, are often proprietary, need expensive training to use, may need hardware upgrades and are aimed more at billing and coding than making the end user, the physician’s life easier. Implementation of an EHR can cost a single physician $163,765 with EHRs having cost the healthcare industry $50.6 billion from 2009-2015. Healthcare organizations have to configure in the cost of support personnel, upgrade fees and other long-term costs which vary wildly from vendor to vendor. There are still barriers (mainly cost of adoption and technophobia) to EMR adoption.