Physicians' Well-Being Linked To In-Basket Messages Generated By Algorithms In Electronic Health Records

Health Aff (Millwood). 2019 Jul;38(7):1073-1078. doi: 10.1377/hlthaff.2018.05509.


Despite concerns about physicians' workload associated with electronic health records (EHRs), little attention has been paid to the relationship between physicians' well-being and the in-basket messages physicians receive-specifically, their volume and sources. Analyses of EHR work performed by physicians in a multispecialty practice found that in-basket messages generated by the EHR system accounted for almost half (114) of the 243 weekly in-basket messages received per physician, on average-far exceeding the numbers received from their colleagues (53) and patients (30). In a survey, 36 percent of the physicians reported burnout symptoms, and 29 percent intended to reduce their clinical work time in the upcoming year. Receiving more than the average number of system-generated in-basket messages was associated with 40 percent higher probability of burnout and 38 percent higher probability of intending to reduce clinical work time. Physicians' perceptions of a positive work environment were associated with lower odds of burnout and intention to reduce clinical work time and with greater satisfaction with life. Female physicians had a higher risk of burnout and lower satisfaction with life, compared to males. Meaningful redesign of EHR in-basket workflow and a wellness-enhancing work environment are necessary to effectively improve physicians' well-being.

Keywords: Physician well-being; burnout; electronic health records; work environment.

Publication types

  • Observational Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Algorithms*
  • Burnout, Professional / psychology
  • California
  • Electronic Health Records*
  • Electronic Mail / statistics & numerical data*
  • Female
  • Humans
  • Male
  • Middle Aged
  • Physicians / psychology*
  • Sex Factors
  • Workload / statistics & numerical data*