Background: Epic is one of the largest electronic medical record (EMR) systems and the seemingly endless workflows can be overwhelming. Burnout has been linked to EMRs and shown to be a factor in physician depression and poor outcomes [1]. Our faculty’s responses to our institution’s 2017 survey of physicians showed that administrative burden is the most negative aspect of clinical practice, with 3 of the top 4 (of 20) most burdensome administrative tasks directly attributable to the EMR: 1) In-Basket management, 2) ambulatory clinical documentation, 3) prior authorizations, and 4) patient communication via the online portal.  Thus, we hypothesized that customized urology-specific tools that could be used to aid in documentation could be provided to care teams in a customized fashion to significantly improve work flow, streamline patient care, and reduce administrative burden. 

Objective: The most efficient workflows should be curated, developed, and implemented to improve efficiency and save time. This study looks at whether a customized workflow created for the urology department along with EPIC retraining for physicians would reduce burnout.

9 physicians underwent EPIC retraining. Pre- and post-retraining surveys looked at several different metrices:  (1) satisfaction (1=very disappointed to 5=very satisfied), (2) burnout (never=1 to everyday=7), and (3) administrative burden (percentage of time spent on different aspects of practice). These surveys were administered after 2 hours of retraining, which included observation, demonstration, gifting SmartPhrases and order sets, and individualized Epic customization. Pre- and post-means were compared with 2-tailed t-test.

Total burnout was not significant (pre-training mean=68.6 versus post-training mean=55.7, p=0.08). Opportunities to consult with peers outside of practice improved after EPIC retraining (pre=3.22 versus post=4, p=0.03). When asked how often physicians lose enthusiasm on a scale of 1=never to 7=everyday,  enthusiasm improved after retraining  (pre=2.3 versus post=1.7, p=0.01). Finally on a scale of 1-100%,  physicians reported less percentage time spent on  least satisfying aspects about medical practice (pre=27.8% versus post=12.4%, p=0.04). When asked to freely express the worst aspects of work, physicians reported:

Long hours (5)
Lack of personal time	(4)
Reimbursement/compensation issues (1)
Clinical documentation (6)
Managed care (1)
Productivity requirements	(2)
Lack of control over practice environment (4)
Liability/defensive medical practices (2)
Non-clinical documentation (1)

Retraining improves enthusiasm and decreases time spent on the least satisfying aspects of work. Physicians are more enthused and there were more opportunities to convene with peers. Total burnout was not reduced significantly, but trended towards significance. In line with previous research studies, 6 physicians or 66% of the physician population reported clinical documentation as one of the worst aspects of work. The other worst aspects of the work include long hours, lack of personal time, and lack of control over practice environment.

Burnout is an important issue that affects many physicians and the electronic medical record has been implicated in its propagation. EPIC retraining improves enthusiasm and decreases time spent on the least satisfying aspects of work. This study suggests that physicians should not only be literate but fluent in EPIC. A larger study and further research in this area is crucial as Epic micro-efficiencies may be key to remedying burnout.

Babbott S, Manwell LB, Brown R, et al. Electronic medical records and physician stress in primary care: results from the MEMO Study. J AM Med Inform Assoc. 2014. 21(e1):e100-6.