{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,4]],"date-time":"2026-10-04T15:53:09Z","timestamp":1791129189645,"version":"4.1.0"},"reference-count":29,"publisher":"Wiley","issue":"7","license":[{"start":{"date-parts":[[2026,10,4]],"date-time":"2026-10-04T00:00:00Z","timestamp":1791072000000},"content-version":"vor","delay-in-days":3,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T00:00:00Z","timestamp":1790812800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Evaluation Clinical Practice"],"published-print":{"date-parts":[[2026,10]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Rationale<\/jats:title>\n                    <jats:p>Physician burnout is a major concern, particularly during periods of large\u2010scale institutional change such as electronic health record (EHR) implementation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Aims and Objectives<\/jats:title>\n                    <jats:p>To examine associations of burnout with physician age, clinical experience, and after\u2010hours documentation burden (\u2018pyjama time\u2019) among acute and post\u2010acute care physicians undergoing EHR implementation, and secondarily to evaluate changes in burnout across three phases of EHR implementation (Pre\u2010Implementation, Post\u2010Implementation, Post\u2010Optimisation).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted anonymous electronic surveys of acute and post\u2010acute care attending physicians at a tertiary academic health system in Toronto, Canada across three phases of EHR implementation. Burnout was assessed using the Maslach Burnout Inventory Human Services Survey\u2013Medical Personnel (MBI\u2010HSS\u2010MP). Univariable and multivariable logistic regression analyses identified factors associated with high emotional exhaustion, high depersonalisation, and low personal accomplishment.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      We collected 306 responses in Pre\u2010Implementation, 248 in Post\u2010Implementation, and 214 in Post\u2010Optimisation. Overall burnout levels remained stable across implementation phases (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009\u2265\u20090.05). Physician age \u2265\u200965 years was independently protective across all burnout domains (adjusted odds ratio [aOR] 0.33\u20100.49;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.01). Physicians with &gt;\u200920 years in practice were less likely to report high depersonalisation (OR 0.39;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.01) or low personal accomplishment (OR 0.54;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.01). Increasing pyjama time was associated with higher odds of emotional exhaustion on univariable analysis (OR 1.06 per hour;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.03) and remained independently associated with depersonalisation after adjustment (aOR 1.07;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.02). Documentation burden peaked in the Post\u2010Implementation phase (mean pyjama time 381.6\u2009min\/day), with higher depersonalisation observed on univariable analysis (OR 1.51;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.02), although this association attenuated after adjustment.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>In this three\u2010phase study, after\u2010hours documentation burden was strongly associated with depersonalisation, while physician age \u2265\u200965 years consistently protected against burnout. Although overall burnout levels remained stable across implementation phases, the immediate Post\u2010Implementation period was characterised by substantial documentation burden and transient increases in depersonalisation, highlighting the importance of robust training, workflow optimisation, and targeted support during early EHR adoption.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/jep.70648","type":"journal-article","created":{"date-parts":[[2026,10,4]],"date-time":"2026-10-04T15:32:41Z","timestamp":1791127961000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Physician Factors Associated With Burnout During System\u2010Wide Electronic Health Record Implementation: A Prospective Repeated Cross\u2010Sectional Study of Acute and Post\u2010Acute Care Physicians"],"prefix":"10.1111","volume":"32","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5038-0548","authenticated-orcid":false,"given":"Yerin R.","family":"Lee","sequence":"first","affiliation":[{"name":"Temerty Faculty of Medicine University of Toronto Toronto Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Louise","family":"Harris","sequence":"additional","affiliation":[{"name":"Temerty Faculty of Medicine University of Toronto Toronto Ontario Canada"},{"name":"University Health Network Toronto Ontario Canada"},{"name":"Department of Medicine University of Toronto Toronto Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter","family":"Rossos","sequence":"additional","affiliation":[{"name":"Temerty Faculty of Medicine University of Toronto Toronto Ontario Canada"},{"name":"University Health Network Toronto Ontario Canada"},{"name":"Department of Medicine University of Toronto Toronto Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lucas B.","family":"Chartier","sequence":"additional","affiliation":[{"name":"University Health Network Toronto Ontario Canada"},{"name":"Department of Medicine University of Toronto Toronto Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1057-3630","authenticated-orcid":false,"given":"Maxim","family":"Ben\u2010Yakov","sequence":"additional","affiliation":[{"name":"Temerty Faculty of Medicine University of Toronto Toronto Ontario Canada"},{"name":"University Health Network Toronto Ontario Canada"},{"name":"Department of Medicine University of Toronto Toronto Ontario Canada"},{"name":"Department of Emergency Medicine University of Toronto Toronto Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,10,4]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"crossref","first-page":"171","DOI":"10.2147\/LRA.S240564","article-title":"Burnout in Healthcare Workers: Prevalence, Impact and Preventative Strategies","volume":"13","author":"De Hert S.","year":"2020","journal-title":"Local and Regional Anesthesia"},{"issue":"3","key":"e_1_2_10_3_1","doi-asserted-by":"crossref","first-page":"373","DOI":"10.1007\/s11739-018-1815-0","article-title":"Effect of Emergency Physician Burnout on Patient Waiting Times","volume":"13","author":"Wolfe R. E.","year":"2018","journal-title":"Internal and Emergency Medicine"},{"issue":"20","key":"e_1_2_10_4_1","first-page":"9058","article-title":"Burnout Syndrome Among Emergency Medicine Physicians: An Update on Its Prevalence and Risk Factors","volume":"23","author":"Boutou A.","year":"2019","journal-title":"European Review for Medical and Pharmacological Sciences"},{"issue":"4","key":"e_1_2_10_5_1","doi-asserted-by":"crossref","first-page":"414","DOI":"10.1080\/13548506.2018.1539236","article-title":"Impact of Physician Workload on Burnout in the Emergency Department","volume":"24","author":"Watson A. G.","year":"2019","journal-title":"Psychology, Health and Medicine"},{"issue":"2","key":"e_1_2_10_6_1","doi-asserted-by":"crossref","first-page":"99","DOI":"10.1002\/job.4030020205","article-title":"The Measurement of Experienced Burnout","volume":"2","author":"Maslach C.","year":"1981","journal-title":"Journal of Organizational Behavior"},{"issue":"12","key":"e_1_2_10_7_1","doi-asserted-by":"crossref","first-page":"1600","DOI":"10.1016\/j.mayocp.2015.08.023","article-title":"Changes in Burnout and Satisfaction With Work\u2010Life Balance in Physicians and the General US Working Population Between 2011 and 2014","volume":"90","author":"Shanafelt T. 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W.","year":"1988","journal-title":"Journal of Applied Psychology"},{"issue":"3","key":"e_1_2_10_11_1","first-page":"421","article-title":"Effect of Emergency Physician Burnout on Patient Waiting Times","volume":"13","author":"De Stefano C.","year":"2018","journal-title":"Internal and Emergency Medicine"},{"issue":"1","key":"e_1_2_10_12_1","first-page":"15","article-title":"Implementing Electronic Medical Records in Canadian Emergency Departments","volume":"21","author":"Rosenfield D.","year":"2019","journal-title":"CJEM: Canadian Journal of Emergency Medical Care = JCMU: Journal Canadien de Soins Medicaux d'urgence"},{"issue":"4","key":"e_1_2_10_13_1","doi-asserted-by":"crossref","first-page":"1","DOI":"10.7249\/rhq-03-04-01","article-title":"Factors Affecting Physician Professional Satisfaction and Their Implications for Patient Care, Health Systems, and Health Policy","volume":"3","author":"Friedberg M.","year":"2014","journal-title":"Rand Health Quarterly"},{"issue":"1","key":"e_1_2_10_14_1","doi-asserted-by":"crossref","first-page":"50","DOI":"10.7326\/M18-0139","article-title":"Physician Burnout in the Electronic Health Record Era: Are We Ignoring the Real Cause?","volume":"169","author":"Downing N. 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A.","year":"1996","journal-title":"International Journal of Social Psychiatry"},{"issue":"2","key":"e_1_2_10_29_1","doi-asserted-by":"crossref","first-page":"300","DOI":"10.1080\/13607860802459831","article-title":"Secrets to Psychological Success: Why Older Doctors Might Have Lower Psychological Distress and Burnout Than Younger Doctors","volume":"13","author":"Peisah C.","year":"2009","journal-title":"Aging and Mental Health"},{"issue":"4","key":"e_1_2_10_30_1","doi-asserted-by":"crossref","first-page":"949","DOI":"10.1097\/01.AOG.0000258299.45979.37","article-title":"Predictors of Physician Career Satisfaction, Work\u2010Life Balance, and Burnout","volume":"109","author":"Keeton K.","year":"2007","journal-title":"Obstetrics and Gynecology"}],"container-title":["Journal of Evaluation in Clinical Practice"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/jep.70648","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/jep.70648","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/jep.70648","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,4]],"date-time":"2026-10-04T15:32:45Z","timestamp":1791127965000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/jep.70648"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,10]]},"references-count":29,"journal-issue":{"issue":"7","published-print":{"date-parts":[[2026,10]]}},"alternative-id":["10.1111\/jep.70648"],"URL":"https:\/\/doi.org\/10.1111\/jep.70648","archive":["Portico"],"relation":{},"ISSN":["1356-1294","1365-2753"],"issn-type":[{"value":"1356-1294","type":"print"},{"value":"1365-2753","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,10]]},"assertion":[{"value":"2026-01-23","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-09-25","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-10-04","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e70648"}}