{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,16]],"date-time":"2026-05-16T06:41:28Z","timestamp":1778913688113,"version":"3.51.4"},"reference-count":34,"publisher":"Georg Thieme Verlag KG","issue":"03","funder":[{"name":"VA National Center for Patient Safety, and the Agency for Health Care Research and Quality","award":["(R01HS022087 and R21HS023602)"],"award-info":[{"award-number":["(R01HS022087 and R21HS023602)"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Appl Clin Inform"],"published-print":{"date-parts":[[2017,7]]},"abstract":"<jats:title>Summary<\/jats:title><jats:p>Background: Electronic health records (EHRs) have been shown to increase physician workload. One EHR feature that contributes to increased workload is asynchronous alerts (also known as inbox notifications) related to test results, referral responses, medication refill requests, and messages from physicians and other health care professionals. This alert-related workload results in negative cognitive outcomes, but its effect on affective outcomes, such as burnout, has been under-studied.<\/jats:p><jats:p>Objectives: To examine EHR alert-related workload (both objective and subjective) as a predictor of burnout in primary care providers (PCPs), in order to ultimately inform interventions aimed at reducing burnout due to alert workload.<\/jats:p><jats:p>Methods: A cross-sectional questionnaire and focus group of 16 PCPs at a large medical center in the southern United States.<\/jats:p><jats:p>Results: Subjective, but not objective, alert workload was related to two of the three dimensions of burnout, including physical fatigue (p = 0.02) and cognitive weariness (p = 0.04), when controlling for organizational tenure. To reduce alert workload and subsequent burnout, participants indicated a desire to have protected time for alert management, fewer unnecessary alerts, and improvements to the EHR system.<\/jats:p><jats:p>Conclusions: Burnout associated with alert workload may be in part due to subjective differences at an individual level, and not solely a function of the objective work environment. This suggests the need for both individual and organizational-level interventions to improve alert workload and subsequent burnout. Additional research should confirm these findings in larger, more representative samples.<\/jats:p><jats:p>\n          Citation: Gregory ME, Russo E, Singh H. Electronic health record alert-related workload as a predictor of burnout in primary care providers. Appl Clin Inform 2017; 8: 686\u2013697 https:\/\/doi.org\/10.4338\/ACI-2017-01-RA-0003\n        <\/jats:p>","DOI":"10.4338\/aci-2017-01-ra-0003","type":"journal-article","created":{"date-parts":[[2017,7,5]],"date-time":"2017-07-05T16:22:22Z","timestamp":1499271742000},"page":"686-697","source":"Crossref","is-referenced-by-count":157,"title":["Electronic Health Record Alert-Related Workload as a Predictor of Burnout in Primary Care Providers"],"prefix":"10.4338","volume":"08","author":[{"given":"Elise","family":"Russo","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hardeep","family":"Singh","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Megan E.","family":"Gregory","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"194","published-online":{"date-parts":[[2017,12,20]]},"reference":[{"key":"ref1","doi-asserted-by":"crossref","first-page":"505","DOI":"10.1197\/jamia.M1700","article-title":"The impact of electronic health records on time efficiency of physicians and nurses: A systematic review","volume":"12","author":"L Poissant","year":"2005","journal-title":"J Am Med Inform Assoc"},{"key":"ref2","doi-asserted-by":"crossref","first-page":"209-e1","DOI":"10.1016\/j.amjmed.2011.07.029","article-title":"Notifications received by primary care practitioners in electronic health records: A taxonomy and time analysis","volume":"125","author":"DR Murphy","year":"2012","journal-title":"Am J Med"},{"key":"ref3","doi-asserted-by":"crossref","first-page":"559","DOI":"10.1001\/jamainternmed.2016.0209","article-title":"The burden of inbox notifications in commercial electronic health records","volume":"176","author":"DR Murphy","year":"2016","journal-title":"JAMA Intern Med"},{"key":"ref4","doi-asserted-by":"crossref","first-page":"727","DOI":"10.1136\/amiajnl-2012-001267","article-title":"Primary care practitioners\u2019 views on test result management in EHR-enabled health systems: A national survey","volume":"20","author":"H Singh","year":"2012","journal-title":"J Am Med Inform Assoc"},{"key":"ref5","first-page":"702","article-title":"(2013)","volume":"173","author":"H Singh","year":"2013","journal-title":"Information overload and missed test results in electronic health record\u2013based settings. JAMA Intern Med"},{"key":"ref6","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/1472-6947-11-22","article-title":"Understanding the management of electronic test result notifications in the outpatient setting","volume":"11","author":"SJ Hysong","year":"2011","journal-title":"BMC Med Inform Decis Mak"},{"key":"ref7","doi-asserted-by":"crossref","first-page":"637","DOI":"10.1037\/a0027060","article-title":"Is burnout static or dynamic? A career transition perspective of employee burnout trajectories","volume":"97","author":"BB Dunford","year":"2012","journal-title":"J Appl Psychol"},{"key":"ref8","doi-asserted-by":"crossref","first-page":"699","DOI":"10.1037\/a0026914","article-title":"Job burnout and depression: Unraveling their temporal relationship and considering the role of physical activity","volume":"97","author":"S Toker","year":"2012","journal-title":"J Appl Psychol"},{"key":"ref9","doi-asserted-by":"crossref","first-page":"1987","DOI":"10.1001\/jama.288.16.1987","article-title":"Hospital nurse staffing and patient mortality, nurse burnout, and job dissatisfaction","volume":"288","author":"LH Aiken","year":"2002","journal-title":"JAMA"},{"key":"ref10","doi-asserted-by":"crossref","first-page":"621","DOI":"10.2307\/258593","article-title":"A review and an integration of research on job burnout","volume":"18","author":"CL Cordes","year":"1993","journal-title":"Acad Manage Rev"},{"key":"ref11","doi-asserted-by":"crossref","first-page":"397","DOI":"10.1146\/annurev.psych.52.1.397","article-title":"Job burnout","volume":"52","author":"C Maslach","year":"2001","journal-title":"Annu Rev Psychol"},{"key":"ref12","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/1741-7015-2-29","article-title":"Stress, burnout and doctors\u2019 attitudes to work are determined by personality and learning style: A twelve year longitudinal study of UK medical graduates","volume":"2","author":"IC McManus","year":"2004","journal-title":"BMC Med"},{"key":"ref13","doi-asserted-by":"crossref","first-page":"12","DOI":"10.1097\/00003727-198402000-00005","article-title":"The need for an operational definition of burnout","volume":"6","author":"PL Brill","year":"1984","journal-title":"Fam Community Health"},{"key":"ref15","first-page":"95","volume-title":"Burning out: A framework","author":"L Hallsten","year":"1993"},{"key":"ref16","first-page":"1431","article-title":"Estimates of costs of primary care physician turnover","volume":"5","author":"SB Buchbinder","year":"1999","journal-title":"Am J Manag Care"},{"key":"ref17","doi-asserted-by":"crossref","first-page":"122","DOI":"10.1046\/j.1525-1497.2000.02219.x","article-title":"Is the professional satisfaction of general internists associated with patient satisfaction?","volume":"15","author":"JS Haas","year":"2000","journal-title":"J Gen Intern Med"},{"key":"ref18","doi-asserted-by":"crossref","first-page":"e0159015.","DOI":"10.1371\/journal.pone.0159015","article-title":"Healthcare staff wellbeing, burnout, and patient safety: A systematic review","volume":"11","author":"LH Hall","year":"2016","journal-title":"PLoS One"},{"key":"ref19","doi-asserted-by":"crossref","first-page":"334","DOI":"10.7326\/0003-4819-149-5-200809020-00008","article-title":"Burnout and suicidal ideation among US medical students","volume":"149","author":"LN Dyrbye","year":"2008","journal-title":"Ann Intern Med"},{"key":"ref20","doi-asserted-by":"crossref","first-page":"2880","DOI":"10.1001\/jama.292.23.2880","article-title":"Resident burnout","volume":"292","author":"NK Thomas","year":"2004","journal-title":"JAMA"},{"key":"ref21","doi-asserted-by":"crossref","first-page":"1377","DOI":"10.1001\/archinternmed.2012.3199","article-title":"Burnout and satisfaction with work-life balance among US physicians relative to the general US population","volume":"172","author":"TD Shanafelt","year":"2012","journal-title":"Arch Intern Med"},{"key":"ref23","doi-asserted-by":"crossref","first-page":"1371","DOI":"10.1177\/0018726706071649","article-title":"The independent relationships of objective and subjective workload with couples\u2019 mood","volume":"59","author":"IH Van Emmerik","year":"2006","journal-title":"Hum Relat"},{"key":"ref24","first-page":"131","article-title":"(2011)","volume":"1","author":"P Hoonakker","year":"2011","journal-title":"Measuring workload of ICU nurses with a questionnaire survey: The NASA Task Load Index (TLX). IEE Trans Healthc Syst Eng"},{"key":"ref25","doi-asserted-by":"crossref","first-page":"125","DOI":"10.1177\/0018720814539505","article-title":"The psychometrics of mental workload multiple measures are sensitive but divergent","volume":"57","author":"G Matthews","year":"2015","journal-title":"Hum Factors"},{"key":"ref26","first-page":"25","volume-title":"Burnout in work organizations","author":"A Shirom","year":"1989"},{"key":"ref27","first-page":"245","volume-title":"Job-related burnout: A review","author":"A Shirom","year":"2003"},{"key":"ref28","doi-asserted-by":"crossref","first-page":"176","DOI":"10.1037\/1072-5245.13.2.176","article-title":"A comparison of the construct validity of two burnout measures in two groups of professionals","volume":"13","author":"A Shirom","year":"2006","journal-title":"Intl J Stress Manag"},{"key":"ref29","first-page":"169","volume-title":"Personnel","author":"W Schaufeli","year":"1998"},{"key":"ref30","doi-asserted-by":"crossref","first-page":"499","DOI":"10.1037\/0021-9010.86.3.499","article-title":"The job demands-resources model of burnout","volume":"86","author":"E Demerouti","year":"2001","journal-title":"J Appl Psychol"},{"key":"ref31","doi-asserted-by":"crossref","first-page":"121","DOI":"10.1097\/PTS.0b013e3181ddf652","article-title":"Ten strategies to improve management of abnormal test result alerts in the electronic health record","volume":"6","author":"H Singh","year":"2010","journal-title":"J Patient Saf"},{"key":"ref32","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":"TD Shanafelt","year":"2016","journal-title":"Mayo Clin Proc"},{"key":"ref33","first-page":"560","volume-title":"Stress in organizations","author":"S Sonnentag","year":"2013"},{"key":"ref35","doi-asserted-by":"crossref","first-page":"170","DOI":"10.1177\/2327857914031028","article-title":"Integrating electronic health records into clinical workflow: An application of human factors modeling methods to ambulatory care","volume":"3","author":"SZ Lowry","year":"2014","journal-title":"Proceedings of the International Symposium on Human Factors and Ergonomics in Health Care"},{"key":"ref36","doi-asserted-by":"crossref","first-page":"945","DOI":"10.2466\/pr0.1989.64.3.945","article-title":"Substitution of self-reporting for observing time spent on work activities by mental health professionals","volume":"64","author":"B Foster","year":"1989","journal-title":"Psychol Rep"},{"key":"ref37","doi-asserted-by":"crossref","first-page":"110","DOI":"10.1197\/jamia.M2187","article-title":"Correlates of electronic health record adoption in office practices: A statewide survey","volume":"14","author":"SR Simon","year":"2007","journal-title":"J Am Med Inform Assoc"}],"container-title":["Applied Clinical Informatics"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/www.thieme-connect.de\/products\/ejournals\/pdf\/10.4338\/ACI-2017-01-RA-0003.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,5,31]],"date-time":"2023-05-31T11:39:35Z","timestamp":1685533175000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.thieme-connect.de\/DOI\/DOI?10.4338\/ACI-2017-01-RA-0003"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2017,7]]},"references-count":34,"journal-issue":{"issue":"03","published-online":{"date-parts":[[2017,12,20]]},"published-print":{"date-parts":[[2017,7]]}},"URL":"https:\/\/doi.org\/10.4338\/aci-2017-01-ra-0003","archive":["Portico","CLOCKSS"],"relation":{},"ISSN":["1869-0327"],"issn-type":[{"value":"1869-0327","type":"electronic"}],"subject":[],"published":{"date-parts":[[2017,7]]}}}