Physician Wellness and the EHR Inbox

I just read and want to share a great article from Health Affairs entitled Physicians’ Well-Being Linked To In-Basket Messages Generated By Algorithms In Electronic Health Records. (I appreciate free open access education so 2 thumbs up to Health Affairs for offering this article FREE. Get the article here in PDF form)

As federal meaningful use regulations continue to shape how we deliver care, the impact of “desktop medicine” workload absolutely does have to be examined and I’m so glad this colleagues did just that! 

Study Breakdown

It was an observational study at a multi-specialty organization who was an early adopter of EPIC (in 1999 in fact) with 934 physicians responding (out of 1292, meaning 358 or 72%  opted to respond). They distributed a 5 question survey, examined in-box messages over a 6 week period and measured the time each doctor spent entering progress notes. Additional measures were response on more questions about being valued, work environment, control of their work and wellness practices. They did obtain sociodemographic info and the physician’s speciality.

My Pearls

—Before this study, only one other paper had been written on the role played by EHR on burnout

 (which was this one: Shanafelt TD, Dyrbye LN, Sinsky C, Hasan O, Satele D, Sloan J, et al. Relationship between clerical burden and characteristics of the electronic environment with physician burnout and professional satisfaction. Mayo Clin Proc. 2016;91(7): 836–48. 4 Friedberg M)

—Many of the organization’s physicians responded which I found to be amazing. In most wellness studies, less than 50% of organizations possible physicians respond so I was impressed.

—Their one question on burnout may have underestimate the level of burnout in this sample.

—They only measured the messages coming in and didn’t review those that were read or responded to. However, I would believe that each of those messages were read and dealt with appropriately by these docs.

—Average number of weekly in-basket messages: 243. Almost half (114) of these messages were system generated (ie pending orders automatically sent to the physician based on algorithm-driven health maintenance reminders, requests for prior authorizations, patient reminders, etc)

—Average number of patient messages: 30

—Average number of message from other physicians or members of the health team: 53

—Only 12% of physicians answered ‘Yes, completely true’ to “Physicians are highly valued.” Yikes!

—(Here’s the real kicker for me) 42% of doctors were above the average of these numbers BUT only 29% of these physicians reported working full time! Talk about a mismatch

—Female physicians reported lower life satisfaction than males counterparts.

—Family Medicine and Internal Medicine received disproportionately higher numbers of system generated messages. Though these type of messages are suppose to help with certain processes of care, the authors speculated that they could be contributing to the perceived and realized loss of autonomy


There’s more in this article but overall I found it hopeful in the fact that is brought to light evidence of what we as the physician community has been saying. Can I get an Amen?.

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