Electronic Health Record Use Patterns Among Well-Being Survey Responders and Nonresponders: Longitudinal Observational Study

Abstract

Background: Physician surveys provide indispensable insights into physician experience, but the question of whether responders are representative can limit confidence in conclusions. Ubiquitously collected electronic health record (EHR) use data may improve understanding of the experiences of survey nonresponders in relation to responders, providing clues regarding their well-being.

Objective: The aim of the study was to identify EHR use measures corresponding with physician survey responses and examine methods to estimate population-level survey results among physicians.

Methods: This longitudinal observational study was conducted from 2019 through 2020 among academic and community primary care physicians. We quantified EHR use using vendor-derived and investigator-derived measures, quantified burnout symptoms using emotional exhaustion and interpersonal disengagement subscales of the Stanford Professional Fulfillment Index, and used an ensemble of response propensity-weighted penalized linear regressions to develop a burnout symptom prediction model.

Results: Among 697 surveys from 477 physicians with a response rate of 80.5% (697/866), always responders were similar to nonresponders in gender (204/340, 60% vs 38/66, 58% women; P=.78) and age (median 50, IQR 40-60 years vs median 50, IQR 37.5-57.5 years; P=.88) but with higher clinical workload (median 121.5, IQR 58.5-184 vs median 34.5, IQR 0-115 appointments; P<.001), efficiency (median 5.2, IQR 4.0-6.2 vs median 4.3, IQR 0-5.6; P<.001), and proficiency (median 7.0, IQR 5.4-8.5 vs median 3.1, IQR 0-6.3; P<.001). Survey response status prediction showed an out-of-sample area under the receiver operating characteristics curve of 0.88 (95% CI 0.77-0.91). Burnout symptom prediction showed an out-of-sample area under the receiver operating characteristics curve of 0.63 (95% CI 0.57-0.70). The predicted burnout prevalence among nonresponders was 52%, higher than the observed prevalence of 28% among responders, resulting in an estimated population burnout prevalence of 31%.

Conclusions: EHR use measures showed limited utility for predicting burnout symptoms but allowed discrimination between responders and nonresponders. These measures may enable qualitative interpretations of the effects of nonresponders and may inform survey response maximization efforts.

Keywords: EHR; burnout; electronic health record; electronic health record metadata; electronic medical record; experiences; health records; longitudinal studies; observational studies; patient record; personal health record; physicians; response bias; surveys; use; well-being.