Electronic health record (EHR) systems have transformed the medical industry. Despite their known benefits, their implementation has resulted in new digital administrative tasks and responsibilities for physicians. This increase in administrative burden has been shown to contribute to physician burnout. Most sources of EHR–related burnout can be categorized into three groups: poor usability, excessive time spent in the EHR, and inefficient workflows. Evidence-based interventions for EHR–related burnout focus on training and education, which improve efficiency in EHR use and may reduce burnout. Optimization of the EHR interface, including personalization and use of targeted workflows, can help address physician frustrations and improve productivity. In the United States, the federal government regulates EHR system development and sets usability requirements. These requirements are critical because visualization and operational design of the user interface have been shown to directly affect patient care and safety. Negative effects of EHR implementation generally are related to increased administrative burden. Positive effects include greater clinician productivity and administrative cost savings. EHR adoption has consistently been associated with positive financial and clinical outcomes. Federal laws continue to be implemented to improve EHR usability, interoperability, and standards for data access and security.

Case 1. The manager of a 15-physician family practice reviews the financial records for the office and finds a sixth straight quarter of financial losses. The major causes of revenue loss include documentation that does not meet billing standards, patients leaving to seek care at other health systems, and physician turnover, which results in training and onboarding costs. Patient satisfaction reports show that physicians appear to be distracted by use of the electronic health record (EHR) during visits, consistently miss electronic prescription refills, and fail to answer patient portal messages. The practice manager notes that this is the fourth year in a row that the practice has been required to pay penalties for not meeting participation requirements for the Medicare Merit-based Incentive Payment System (MIPS).