Analysis of EHR record use identified physicians at high risk of departure

Exacerbated most recently by the pandemic, physician burnout has been particularly pervasive. Prospectively tracking metrics in the electronic health record (EHR) may identify physicians at high risk of departure.

Prior to the pandemic, physician burnout was a top concern of healthcare organizations, but it has been exacerbated by the pandemic. A new study published in JAMA Network Open found tracking physician productivity and electronic health record (EHR) metrics may help identify which physicians are at a high risk of departing.

Physician replacement costs (including recruitment, lost revenue, onboarding, and time onboard new hires) have been calculated to cost as much as $1 million to the health care organization per physician departure. At the national level, this equates to about $4.6 billion annually.

Prior studies have uncovered associations between professional physician satisfaction, burnout, intention to leave, and actual reduction in professional effort. Given the amount of physician hours spent on EHR activities and its own association with professional burnout, it is understandable that physician dissatisfaction with the EHR system has been correlated with intention to reduce clinical worth in the next year.

However, the new study counterintuitively found less time on the HER was associated with physician departure. In the retrospective cohort study of ambulatory physician turnover, the authors examined physician turnover, productivity, and EHR use from March 2018 to February 2020 in a large ambulatory practice network inclusive of 141 practices sites in New England.

The study included 314 physicians with a corresponding 5728 physician-months of data. The demographics of study participants included 123 (39%) women, 100 (32%) were aged 45 to 54 years, and the turnover rate was 5.1% per year (10.2% total; 32 physicians departed their position during the study period).

The mean values for physician productivity were: demand, 77%; patient volume, 206 completed appointments/month; and intensity, 2.6 patients/ hour. Mean EHR use values were: total EHR time, 5.5 hours; note documentation, 1.9 hours; work outside scheduled clinical hours, 0.8 hours; time on inbox, 0.70 hours; and teamwork, 23%.

The authors found the factors associated with physician departure were less time on EHR and inbox and lower rates of teamwork on order entry.

This first finding was counterintuitive: spending less time on the inbox management of the EHR was associated with physician departure. The authors have noted that it warrants further investigation in future studies.

Of note, physician age, gender, and specialty were not associated with departure.

Overall, this study identified physician demand, inbox time, and teamwork on orders as key variables associated with physician departure, and potential areas where hospital system can implement change to directly address and reduce 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 authors wrote. “Indeed, 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.”