{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,26]],"date-time":"2026-06-26T04:58:36Z","timestamp":1782449916152,"version":"3.54.5"},"reference-count":58,"publisher":"Oxford University Press (OUP)","issue":"2","license":[{"start":{"date-parts":[[2018,12,5]],"date-time":"2018-12-05T00:00:00Z","timestamp":1543968000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"funder":[{"name":"CMS Medicaid Health Information Technology Implementation Advance Planning Document"},{"name":"Health Information Exchange"},{"name":"Rhode Island Executive Office of Health and Human Services"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2019,2,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Objective<\/jats:title>\n                  <jats:p>To quantify how stress related to use of health information technology (HIT) predicts burnout among physicians.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>All 4197 practicing physicians in Rhode Island were surveyed in 2017 on their HIT use. Our main outcome was self-reported burnout. The presence of HIT-related stress was defined by report of at least 1 of the following: poor\/marginal time for documentation, moderately high\/excessive time spent on the electronic health record (EHR) at home, and agreement that using an EHR adds to daily frustration. We used logistic regression to assess the association between each HIT-related stress measure and burnout, adjusting for respondent demographics, practice characteristics, and the other stress measures.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Of the 1792 physician respondents (43% response rate), 26% reported burnout. Among EHR users (91%), 70% reported HIT-related stress, with the highest prevalence in primary care-oriented specialties. After adjustment, physicians reporting poor\/marginal time for documentation had 2.8 times the odds of burnout (95% CI: 2.0\u20134.1; P\u2009&amp;lt;\u2009.0001), compared to those reporting sufficient time. Physicians reporting moderately high\/excessive time on EHRs at home had 1.9 times the odds of burnout (95% CI: 1.4\u20132.8; P\u2009&amp;lt;\u2009.0001), compared to those with minimal\/no EHR use at home. Those who agreed that EHRs add to their daily frustration had 2.4 times the odds of burnout (95% CI: 1.6\u20133.7; P\u2009&amp;lt;\u2009.0001), compared to those who disagreed.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>HIT-related stress is measurable, common (about 70% among respondents), specialty-related, and independently predictive of burnout symptoms. Identifying HIT-specific factors associated with burnout may guide healthcare organizations seeking to measure and remediate burnout among their physicians and staff.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/jamia\/ocy145","type":"journal-article","created":{"date-parts":[[2018,10,17]],"date-time":"2018-10-17T21:57:41Z","timestamp":1539813461000},"page":"106-114","source":"Crossref","is-referenced-by-count":486,"title":["Physician stress and burnout: the impact of health information technology"],"prefix":"10.1093","volume":"26","author":[{"given":"Rebekah L","family":"Gardner","sequence":"first","affiliation":[{"name":"Department of Medicine, Warren Alpert Medical School, Brown University, Providence, Rhode Island, USA"},{"name":"Healthcentric Advisors, Providence, Rhode Island, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emily","family":"Cooper","sequence":"additional","affiliation":[{"name":"Healthcentric Advisors, Providence, Rhode Island, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jacqueline","family":"Haskell","sequence":"additional","affiliation":[{"name":"Healthcentric Advisors, Providence, Rhode Island, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel A","family":"Harris","sequence":"additional","affiliation":[{"name":"Healthcentric Advisors, Providence, Rhode Island, USA"},{"name":"Department of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sara","family":"Poplau","sequence":"additional","affiliation":[{"name":"Hennepin Healthcare Research Institute, Minneapolis, Minnesota, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Philip J","family":"Kroth","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, University of New Mexico School of Medicine, Albuquerque, New Mexico, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark","family":"Linzer","sequence":"additional","affiliation":[{"name":"Department of Medicine, Hennepin County Medical Center, Minneapolis, Minnesota, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2018,12,5]]},"reference":[{"key":"2020110613003594900_ocy145-B1","unstructured":"Noseworthy\n              J\n            , MadaraJ, CosgroveDet al. Physician burnout is a public health crisis: a message to our fellow health care CEOs.\nHealthAffairs Blog. March 28, 2017. http:\/\/healthaffairs.org\/blog\/2017\/03\/28\/physician-burnout-is-a-public-health-crisis-a-message-to-our-fellow-health-care-\u00a0ceos\/Accessed May 8, 2018."},{"issue":"3","key":"2020110613003594900_ocy145-B2","doi-asserted-by":"crossref","first-page":"234","DOI":"10.1097\/01.mlr.0000199848.17133.9b","article-title":"Leaving medicine: the consequences of physician dissatisfaction","volume":"44","author":"Landon","year":"2006","journal-title":"Med Care"},{"issue":"2","key":"2020110613003594900_ocy145-B3","doi-asserted-by":"crossref","first-page":"105","DOI":"10.1097\/01.HMR.0000304509.58297.6f","article-title":"Understanding physicians\u2019 intentions to withdraw from practice: the role of job satisfaction, job stress, mental and physical","volume":"35","author":"Williams","year":"2010","journal-title":"Health Care Manage Rev"},{"key":"2020110613003594900_ocy145-B4","doi-asserted-by":"crossref","first-page":"43","DOI":"10.1136\/postgradmedj-2016-134683","article-title":"A study of the relationship between resilience, burnout and coping strategies in doctors","volume":"94","author":"McCain","year":"2018","journal-title":"Postgrad Med J"},{"issue":"11","key":"2020110613003594900_ocy145-B5","doi-asserted-by":"crossref","first-page":"1471","DOI":"10.7150\/ijms.6743","article-title":"Burnout, job satisfaction, and medical malpractice among physicians","volume":"10","author":"Chen","year":"2013","journal-title":"Int J Med Sci"},{"issue":"6","key":"2020110613003594900_ocy145-B6","doi-asserted-by":"crossref","first-page":"995","DOI":"10.1097\/SLA.0b013e3181bfdab3","article-title":"Burnout and medical errors among American surgeons","volume":"251","author":"Shanafelt","year":"2010","journal-title":"Ann Surg"},{"issue":"4","key":"2020110613003594900_ocy145-B7","doi-asserted-by":"crossref","first-page":"475","DOI":"10.1007\/s11606-016-3886-9","article-title":"The relationship between professional burnout and quality and safety in healthcare: a meta-analysis","volume":"32","author":"Salyers","year":"2017","journal-title":"J Gen Intern Med"},{"issue":"8","key":"2020110613003594900_ocy145-B8","doi-asserted-by":"crossref","first-page":"835","DOI":"10.1111\/j.1365-2923.2011.03985.x","article-title":"Associations between emotional intelligence and doctor burnout, job satisfaction and patient satisfaction","volume":"45","author":"Weng","year":"2011","journal-title":"Med Educ"},{"key":"2020110613003594900_ocy145-B9","doi-asserted-by":"crossref","first-page":"44","DOI":"10.1093\/fampra\/cmt060","article-title":"Is burnout associated with referral rates among primary care physicians in community clinics?","volume":"31 (1)","author":"Kushnir","year":"2014","journal-title":"Fam Pract"},{"issue":"11","key":"2020110613003594900_ocy145-B10","first-page":"1431","article-title":"Estimates of costs of primary care physician turnover","volume":"5","author":"Buchbinder","year":"1999","journal-title":"Am J Manag Care"},{"issue":"12","key":"2020110613003594900_ocy145-B11","doi-asserted-by":"crossref","first-page":"1826","DOI":"10.1001\/jamainternmed.2017.4340","article-title":"The business case for investing in physician well-being","volume":"177","author":"Shanafelt","year":"2017","journal-title":"JAMA Intern Med"},{"issue":"3","key":"2020110613003594900_ocy145-B12","doi-asserted-by":"crossref","first-page":"642","DOI":"10.1016\/j.ygyno.2017.06.026","article-title":"The impact of physician burnout on clinical and academic productivity of gynecologic oncologists: a decision analysis","volume":"146","author":"Turner","year":"2017","journal-title":"Gynecol Oncol"},{"issue":"7","key":"2020110613003594900_ocy145-B13","doi-asserted-by":"crossref","first-page":"836","DOI":"10.1016\/j.mayocp.2016.05.007","article-title":"Relationship between clerical burden and characteristics of the electronic environment with physician burnout and professional satisfaction","volume":"91","author":"Shanafelt","year":"2016","journal-title":"Mayo Clin Proc"},{"key":"2020110613003594900_ocy145-B14","doi-asserted-by":"crossref","first-page":"325","DOI":"10.1186\/1472-6963-14-325","article-title":"How does burnout affect physician productivity? 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August 23, 2017. https:\/\/hbr.org\/2017\/08\/what-one-company-learned-from-forcing-employees-to-use-their-vacation-time?autocomplete= trueAccessed July 5, 2018."},{"issue":"5","key":"2020110613003594900_ocy145-B53","doi-asserted-by":"crossref","first-page":"764","DOI":"10.1136\/amiajnl-2013-002229","article-title":"Electronic health record functionality needed to better support primary care","volume":"21","author":"Krist","year":"2014","journal-title":"J Am Med Inform Assoc"},{"issue":"6","key":"2020110613003594900_ocy145-B54","doi-asserted-by":"crossref","first-page":"745","DOI":"10.3122\/jabfm.2011.06.100255","article-title":"Information chaos in primary care: implications for physician performance and patient safety","volume":"24","author":"Beasley","year":"2011","journal-title":"J Am Board Fam Med"},{"key":"2020110613003594900_ocy145-B55","unstructured":"Centers for Medicare & Medicaid Services. 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