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. 2020 Jul 27;27(9):1401–1410. doi: 10.1093/jamia/ocaa092

Table 3.

Odds of burnout adjusted for elements of electronic health record use and respondent characteristics (N = 422)

Unadjusted model Adjusted model Adjusted model (Subset of clinicians with note composition data)
Workload variables
Number of daily appointments 1.00 0.95 1.01
Minutes spent reviewing charts per week, in 5-min increments 1.02b 1.01 1.01
Medication orders authorized per week
 Quartile 1 Ref Ref Ref
 Quartile 2 1.80a 1.30 1.31
 Quartile 3 2.12b 1.03 0.89
 Quartile 4 1.81a 0.54 0.43
Nonmedication orders authorized per week
 Quartile 1 Ref Ref Ref
 Quartile 2 1.13 0.79 0.75
 Quartile 3 2.02b 0.95 0.75
 Quartile 4 1.98b 0.53 0.43
Patient call messages received per week
 Quartile 1 Ref Ref Ref
 Quartile 2 1.27 1.27 1.65
 Quartile 3 1.47 1.32 1.70
 Quartile 4 2.88c 3.81c 6.59c
Results messages received per week
 Quartile 1 Ref Ref Ref
 Quartile 2 1.55 1.41 1.44
 Quartile 3 1.55 1.19 0.99
 Quartile 4 1.97b 1.49 1.55
Note length per visit, in 500-character increments 1.01 1.00 1.01
Efficiency variables
Any precharting of visit notes
 No Ref Ref Ref
 Yes 0.96 0.74 0.84
Any use of Chart Search function
 No Ref Ref Ref
 Yes 1.50 1.00 0.68
Number of user SmartPhrases 1.00b 1.01a 1.01
Percent of orders placed from preference lists or SmartSets 2.17b 1.90 2.60
Percent of note entered using SmartToolsd
 Quartile 1 Ref Ref
 Quartile 2 2.07a — 1.49
 Quartile 3 1.11 — 0.48
Quartile 4 2.94c — 1.48
Percent of note entered using copy and pasted
 Quartile 1 Ref Ref
 Quartile 2 1.26 — 0.70
 Quartile 3 0.61 — 0.46
 Quartile 4 0.44b — 0.22b
Any use of transcription or voice recognition technology for note entryd
 No Ref Ref
 Yes 0.91 — 1.47
Individual characteristics
Age
 <40 y Ref Ref Ref
 40-60 y 1.12 1.02 0.68
 >60 y 1.89a 2.29b 1.84
Gender
 Male Ref Ref Ref
 Female 1.12 1.12 0.86
Practice size
 1-3 clinicians Ref Ref Ref
 4-15 clinicians 0.70 0.77 0.66
 16 or more clinicians 0.78 1.00 0.76
Primary care clinician
 No Ref Ref Ref
 Yese 2.12c 2.16b 2.51a
Specialty
 Medicine or pediatricsf Ref Ref Ref
 Obstetrics and gynecology 0.61 0.76 0.52
 Psychiatry 0.68 2.67a 5.96b
 Surgery 0.51a 1.62 0.49
 Other/unknown 0.70 1.47 0.87
Use of medical scribe
 No Ref Ref Ref
 Yes 0.45 0.54 1.97
Clinician type
 Advanced practice providerg Ref Ref Ref
 Physician 0.87 1.13 1.51
Health system
 A Ref Ref —
 B 0.80 0.74 —

See Supplementary Table 1 for results with confidence intervals and P values. Epic SmartPhrases are personalized shortcuts to auto-populate large blocks of text in a note by typing a few characters, also known as “dot phrases.” These are either created by the clinician or shared with them by another user. Preference lists within Epic are a personalized set of frequently used orders with information prepopulated. These are either created or modified by the clinician or by institutional information services support. SmartSets, in this context, are a combination of orders related to a particular clinical scenario with information prepopulated; at the time of this study, they could only be created by information services support. SmartTools are a set of documentation shortcuts that enable insertion of preconfigured phrases, selectable lists, and links to data within the electronic health record that are intended to standardize and streamline documentation.

.

P < .10.

b

P < .05.

c

P < .01.

d

Data were available for this variable for 290 clinicians in 1 of the 2 health systems.

e

Survey respondents who replied yes to the question: “Do you provide primary care?”

f

Includes internal medicine, family medicine, and pediatrics.

g

Includes advance practice registered nurses and physician assistants.