As pressures on healthcare teams continue to rise, clinician burnout continues to pose a significant threat to the safe delivery of patient care within health systems globally. Recent research from The University of Bath suggests that half of NHS staff are currently experiencing burnout symptoms, and a survey from the BMA has found up to 73% of trainee GPs to be suffering with the condition.
In April of 2024, working alongside experts from an NHS Trust, colleagues at TORTUS published a narrative review paper in the JMIR Medical Informatics titled ‘Impact of Electronic Health Record Use on Cognitive Loads and Burnout Among Clinicians’. In the paper, we identified multiple studies that show how clinicians’ interactions with electronic health record (EHR) systems can be a contributor to ‘cognitive overload’ – a condition that impacts performance and, over a period of time, can lead to burnout.
Our analysis revealed a clear need to rethink the way in which clinicians interact with EHRs and the way in which such systems are designed and used. These digital records are integral to the efficient, accurate and joined-up delivery of modern care, but, in many cases, there is significant scope for improvements to design, user interface, automation and user training. Ensuring appropriate updates and improvements are rolled out across the board to EHR systems could remove the burden of administrative and repetitive tasks that drain clinicians’ energy and obstruct their ability to deliver high-quality face-to-face patient care.
Below, we share the key takeaways and recommendations from the narrative review paper.
Cognitive Load Theory and EHRs
Cognitive load theory explains that human capacity to process information is limited. When this capacity is exceeded, decision-making is impaired, mental performance disrupted, and stress levels elevated. When clinicians are overwhelmed by cognitive load, their performance can suffer, potentially compromising patient safety. This overload, if sustained, can lead to burnout, characterised by emotional exhaustion, demoralisation, and a reduced sense of personal accomplishment.
Clinicians, who must navigate complex patient data and make critical decisions under pressure, are at high risk of experiencing cognitive overload. Importantly, over recent years, the transition to digital records has increased the volume and complexity of data that clinicians must handle, adding to their cognitive burden. Poorly designed EHR systems exacerbate this issue by presenting inefficient user interfaces, excessive documentation requirements, and numerous pop-up notifications, leading to distraction and alert fatigue.
Addressing the design and implementation of EHRs to reduce cognitive load is therefore a necessary step towards mitigating clinician burnout and ensuring patient safety.
Key strategies to minimise cognitive overload from EHRs
Improving user interfaces and streamlining information presentation
Simplifying the user interface of EHR systems can significantly reduce unnecessary cognitive effort. Designing intuitive menus, reducing the steps needed to complete tasks, and logically organising patient data can help clinicians navigate these systems more efficiently.
Additionally, tailoring the presentation of information to minimise extraneous load is crucial. Displaying critical patient data in a summarised form, with the option to expand details as needed, can prevent information overload. Conversations between clinical, administrative, and compliance teams can help determine the necessity of system pop-up alerts, reducing unnecessary cognitive demands on clinicians.
Incorporating decision support tools
Advanced decision support tools can aid clinicians by providing contextually relevant information at the point of care, reducing the need for extensive data retrieval and analysis. Continuous training and real-time support for users would unlock maximum value from such tools.
Reducing documentation burdens
Equipping clinicians with new generative AI technology has potential to deliver significant reduction in the time devoted to manually updating EHRs. TORTUS, the generative AI assistant built by TORTUS, captures audio in patient consultations and automates the clinical documentation process, interacting with any EHR system to boost efficiency, release cognitive resources, and allow clinicians to devote more attention to patient care. Today, primary and secondary care clinicians using TORTUS report reduced feelings of burnout and improved quality of life, 25% time saved compared to using EHR alone, and a doubling in the quality of their clinical documentation.
Summary
Clinician burnout is a multifaceted issue with various contributing factors, including overall workload, organisational culture, and inflexibility of rostering. While the perfect design and implementation of EHR systems alone cannot eliminate burnout, minimising their cognitive load risk is essential to maximise their significant utility. By scientifically assessing the impact of different EHR technologies and models, healthcare organisations can equip clinicians with the best tools to improve their efficiency and enhance patient outcomes. Addressing EHR challenges offers a practical and potentially cost-effective strategy for reducing burnout and retaining staff within the healthcare workforce.
