Electronic medical records and physician stress in primary care: results from the MEMO Study

Abstract

Background: Little has been written about physician stress that may be associated with electronic medical records (EMR).

Objective: We assessed relationships between the number of EMR functions, primary care work conditions, and physician satisfaction, stress and burnout.

Design and participants: 379 primary care physicians and 92 managers at 92 clinics from New York City and the upper Midwest participating in the 2001-5 Minimizing Error, Maximizing Outcome (MEMO) Study. A latent class analysis identified clusters of physicians within clinics with low, medium and high EMR functions.

Main measures: We assessed physician-reported stress, burnout, satisfaction, and intent to leave the practice, and predictors including time pressure during visits. We used a two-level regression model to estimate the mean response for each physician cluster to each outcome, adjusting for physician age, sex, specialty, work hours and years using the EMR. Effect sizes (ES) of these relationships were considered small (0.14), moderate (0.39), and large (0.61).

Key results: Compared to the low EMR cluster, physicians in the moderate EMR cluster reported more stress (ES 0.35, p=0.03) and lower satisfaction (ES -0.45, p=0.006). Physicians in the high EMR cluster indicated lower satisfaction than low EMR cluster physicians (ES -0.39, p=0.01). Time pressure was associated with significantly more burnout, dissatisfaction and intent to leave only within the high EMR cluster.

Conclusions: Stress may rise for physicians with a moderate number of EMR functions. Time pressure was associated with poor physician outcomes mainly in the high EMR cluster. Work redesign may address these stressors.

Keywords: electronic medical records; outpatient clinics; physicians; primary care; stress, psychological.

Figure 1

EMR functions from the clinic managers’ survey displayed with the probability of the functions in each cluster.

Figure 2

Stress scored on five-point scale, ≥3 defined as ‘stressed’; Satisfaction scored on five-point scale, ≥3 defined as ‘satisfied’; Burnout scored on five-point scale, ≥3 defined as ‘burned out’; Intent to leave scored on five-point scale, ≥3 defined as ‘likely to leave’.