Poor EHR design leads to nurse burnout, higher surgical patient mortality, study finds

Poorly designed electronic health record systems may accelerate clinician burnout and increase risks safety risks for patients having surgery, according to a new study published in Medical Care, the journal of the medical care section of the American Public Health Association.

The study, which included 12,004 nurses, 1.3 million surgical patients and 343 hospitals in four states, found that surgical patients receiving care in hospitals with poor EHR usability were 21% more likely to die in the hospital after their procedures and 6% more likely to be readmitted within 30 days than those being treated in hospitals with better EHR usability.

"EHR systems with poor usability can significantly hinder a nurse's ability to quickly access trusted information for decision making and communication with other members of the health care team," the authors noted. "Lapses in these critical care processes may contribute to significant delays or interruptions to the provision of both inpatient and post-discharge care, and in turn, medical errors and other poor outcomes."

The authors—from the University of Pennsylvania School of Nursing and Corporal Michael J. Crescenz VA Medical Center—are not the first to warn about the impact of EHRs on patient safety. In fact, in 2019, ECRI Institute flagged poor communication of test results and diagnosis within EHRs as one of its top 10 safety concerns for that year.

An American Medical Association and Mayo Clinic study last year that surveyed 5,000 physicians found that EHR usability mostly scored an "F" and was strongly tied to high rates of physician burnout.

For this most recent study, the authors judged EHR usability by nurses' responses to questions about how easy it was to access patient information quickly, how much the system interfered with patient care, how easy it was to use, how much they trusted the system's patient assessment and medication data, how much the system helped them complete work efficiently and how easy it was to share information with other health team members.

Adding to concerns about patient safety, the study found that EHR design can significantly impact nurse job satisfaction. Nurses working with systems that had poor usability were 41% more likely to experience burnout than those with better operating EHRs, 61% more likely to be dissatisfied with their job and 31% more likely to want to leave their position.