CoChat
Sign Up
Cited by 123Electronic Health Records SystemsHealthcare professionals’ stress and burnoutTechnostress in Professional Settings

The burden of the digital environment: a systematic review on organization-directed workplace interventions to mitigate physician burnout

Open access
Thomas Craig, Kelly J, Willis, Van C, Gruen, David, Rhee, Kyu, Jackson, Gretchen P·2021·Journal of the American Medical Informatics Association
DOI 10.1093/jamia/ocaa301PMC PMC8068437
Open this paper in CoChat — free accountOpen PDF

Abstract

Objective: To conduct a systematic review identifying workplace interventions that mitigate physician burnout related to the digital environment including health information technologies (eg, electronic health records) and decision support systems) with or without the application of advanced analytics for clinical care. Materials and Methods: Literature published from January 1, 2007 to June 3, 2020 was systematically reviewed from multiple databases and hand searches. Subgroup analysis identified relevant physician burnout studies with interventions examining digital tool burden, related workflow inefficiencies, and measures of burnout, stress, or job satisfaction in all practice settings. Results: The search strategy identified 4806 citations of which 81 met inclusion criteria. Thirty-eight studies reported interventions to decrease digital tool burden. Sixty-eight percent of these studies reported improvement in burnout and/or its proxy measures. Burnout was decreased by interventions that optimized technologies (primarily electronic health records), provided training, reduced documentation and task time, expanded the care team, and leveraged quality improvement processes in workflows. Discussion: The contribution of digital tools to physician burnout can be mitigated by careful examination of usability, introducing technologies to save or optimize time, and applying quality improvement to workflows. Conclusion: Physician burnout is not reduced by technology implementation but can be mitigated by technology and workflow optimization, training, team expansion, and careful consideration of factors affecting burnout, including specialty, practice setting, regulatory pressures, and how physicians spend their time.

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

A few free checks a day · papers already verified open instantly · results are public

Integrity signals

Registry

Crossref · 10.1093/jamia/ocaa301

Cites

24 of 24 references verified0 citation errors · 0 not checkable

Statistics

Claims the paper makes

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

A few free checks a day · papers already verified open instantly · results are public

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • Burnout among HCPs is closely linked to documentation burden and extensive EHR use.

    “Burnout among HCPs, characterised by emotional exhaustion and depersonalisation has been closely linked to documentation burden and extensive EHR use [2, 35].”

    From Artificial Intelligence (AI) – Powered Documentation Systems in Healthcare: A Systematic Review (2025) · cites this paper as [35]

    The Introduction links physician burnout to EHR-related inefficiencies and clerical burden, and the Discussion connects documentation demands with dissatisfaction and burnout-related interventions. The claim extends this finding to HCPs generally, whereas the Conclusion says more research is needed on digital tools’ effects on other types of clinicians. (LLM, conf=0.87)

    Experimental — accuracy not yet measured

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

The self-check needs the paper’s full text.

Cites

Flagged first, then by citations

Research works printed but not linked: 74

  1. [2]Jones GM, Roe NA, Louden L, et al Factors associated with burnout among us hospital clinical pharmacy practitioners: results of a nationwide pilot survey. Hosp Pharm 2017; 52 (11): 742– 51. 29276254 PMC5735761
  2. [3]Restauri N, Sheridan AD. Burnout and posttraumatic stress disorder in the coronavirus disease 2019 (COVID-19) pandemic: intersection, impact, and interventions. J Am Coll Radiol 2020; doi: 10.1016/j.jacr.2020.05.021 PMC7250786 32479798 · DOI
  3. [6]Khairat S, Coleman C, Ottmar P, et al Association of electronic health record use with physician fatigue and efficiency. JAMA Netw Open 2020; 3 (6): e207385. 32515799 PMC7284310
  4. [7]Kroth PJ, Morioka-Douglas N, Veres S, et al Association of electronic health record design and use factors with clinician stress and burnout. JAMA Netw Open 2019; 2 (8): e199609. 31418810 PMC6704736
  5. [8]Holden RJ. Cognitive performance-altering effects of electronic medical records: An application of the human factors paradigm for patient safety. Cogn Tech Work 2011; 13 (1): 11– 29. PMC3072581 21479125
  6. [9]Sinsky CA, Privitera MR. Creating a “Manageable Cockpit” for clinicians: a shared responsibility. JAMA Intern Med 2018; 178 (6): 741– 2. 29582080
  7. [10]DeChant PF, Acs A, Rhee KB, et al Effect of organization-directed workplace interventions on physician burnout: a systematic review. Mayo Clin Proc Innov Qual Outcomes 2019; 3 (4): 384– 408. 31993558 PMC6978590
  8. [11]Moher D, Liberati A, Tetzlaff J, et al Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Ann Intern Med 2009; 151 (4): 264– 9. 19622511
  9. [12]McHugh ML. Interrater reliability: the kappa statistic. Biochem Med 2012; 22 (3): 276– 82. PMC3900052 23092060
  10. [15]Albadry AA, Sleem AN, Montasser NA, et al Effect of quality improvement intervention on occupational burnout in Mansoura University Hospitals, Egypt. In: proceedings of the WELL-Med Conference May 28–June1, 2014; Alexandroupolis, Greece.
  11. [16]Ali NA, Wolf KM, Hammersley J, et al; on behalf of the Midwest Critical Care Consortium. Continuity of care in intensive care units: a cluster-randomized trial of intensivist staffing. Am J Respir Crit Care Med 2011; 184 (7): 803– 8. 21719756
  12. [17]Amis SM, Osicki THE. Can patient safety be improved by reducing the volume of “inappropriate prescribing tasks” handed over to out-of-hours junior doctors? Int J Gen Med 2018; 11: 105– 12. 29593428 PMC5865568
  13. [20]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– e106. 24005796 PMC3957395
  14. [21]Baccei SJ, Henderson SR, Lo HS, et al Using quality improvement methodology to reduce costs while improving efficiency and provider satisfaction in a busy, academic musculoskeletal radiology division. J Med Syst 2020; 44 (6): 104. 32318828
  15. [22]Beam KS, Cardoso M, Sweeney M, et al Examining perceptions of computerized physician order entry in a neonatal intensive care unit. Appl Clin Inform 2017; 08 (02): 337– 47. PMC6241742 28378024
  16. [23]Bragard I, Etienne AM, Merckaert I, et al Efficacy of a communication and stress management training on medical residents’ self-efficacy, stress to communicate and burnout: a randomized controlled study. J Health Psychol 2010; 15 (7): 1075– 81. 20453053
  17. [24]Butow P, Brown R, Aldridge J, et al Can consultation skills training change doctors’ behaviour to increase involvement of patients in making decisions about standard treatment and clinical trials: a randomized controlled trial. Health Expect 2015; 18 (6): 2570– 83. 24975503 PMC5810732
  18. [25]Butow P, Cockburn J, Girgis A, et al; the CUES Team. Increasing oncologists’ skills in eliciting and responding to emotional cues: evaluation of a communication skills training program. Psycho-Oncol 2008; 17 (3): 209– 18. 17575560
  19. [26]Callahan S, Enfield KB, Sturek J, et al An innovative, evidence-based, fellow-driven bundle to improve professional satisfaction and wellness. Am J Respir Crit Care Med 2018; 197: A4498.
  20. [27]Chapman SA, Blash LK. New roles for medical assistants in innovative primary care practices. Health Serv Res 2017; 52 (Suppl 1): 383– 406. 27859097 PMC5269548
  21. [28]Contratto E, Romp K, Estrada CA, et al Physician order entry clerical support improves physician satisfaction and productivity. South Med J 2017; 110 (5): 363– 8. 28464179
  22. [29]Contratto EC, Estrada C, Romp KG, et al The impact of physician order entry clerical support on physician satisfaction and productivity. J Gen Intern Med 2016; 31 (2 Suppl 1): S912– 3. 28464179
  23. [30]Danila MI, Melnick JA, Curtis JR, et al Use of scribes for documentation assistance in rheumatology and endocrinology clinics: impact on clinic workflow and patient and physician satisfaction. J Clin Rheumatol 2018; 24 (3): 116– 21. 29280815
  24. [31]Desai SV, Asch DA, Bellini LM, et al Education outcomes in a duty-hour flexibility trial in internal medicine. N Engl J Med 2018; 378 (16): 1494– 508. 29557719 PMC6101652
  25. [32]Dunn PM, Arnetz BB, Christensen JF, et al Meeting the imperative to improve physician well-being: assessment of an innovative program. J Gen Intern Med 2007; 22 (11): 1544– 52. 17891503 PMC2219814
  26. [34]Dyrbye LN, West CP, Richards ML, et al A randomized, controlled study of an online intervention to promote job satisfaction and well-being among physicians. Burnout Res 2016; 3 (3): 69– 75.
  27. [35]Ehrlich JR, Michelotti M, Blachley TS, et al A two-year longitudinal assessment of ophthalmologists’ perceptions after implementing an electronic health record system. Appl Clin Inform 2016; 07 (04): 930– 45. PMC5228135 27730248
  28. [36]Fassiotto MA. A time banking system to support workplace flexibility. In: proceedings of the International Conference on Physician Health; September 18–20, 2016; Boston, MA.
  29. [37]Garland A, Roberts D, Graff L. Twenty-four–hour intensivist presence: a pilot study of effects on intensive care unit patients, families, doctors, and nurses. Am J Respir Crit Care Med 2012; 185 (7): 738– 43. 22246176
  30. [38]Giannini A, Miccinesi G, Prandi E, et al; The ODIN Study Group. Partial liberalization of visiting policies and ICU staff: a before-and-after study. Intensive Care Med 2013; 39 (12): 2180– 7. 24013436
  31. [41]Goyal P, Cohen-Mekelburg S, Egan C, et al New uses of old technology: can nurse-pagers improve communication between resident-physicians and nurses. Appl Nurs Res 2018; 44: 1– 5. 30389052
  32. [43]Heaton HA, Castaneda-Guarderas A, Trotter ER, et al Effect of scribes on patient throughput, revenue, and patient and provider satisfaction: a systematic review and meta-analysis. Am J Emerg Med 2016; 34 (10): 2018– 28. 27534432
  33. [44]Heyworth L, Zhang F, Jenter CA, et al Physician satisfaction following electronic health record adoption in three Massachusetts communities. Interact J Med Res 2012; 1 (2): e12. 23611987 PMC3626123
  34. [45]Hung DY, Harrison MI, Truong Q, et al Experiences of primary care physicians and staff following lean workflow redesign. BMC Health Serv Res 2018; 18 (1): 274. 29636052 PMC5894127
  35. [46]Imdieke BH, Martel ML. Integration of medical scribes in the primary care setting: improving satisfaction. J Ambul Care Manage 2017; 40 (1): 17– 25. 27902549
  36. [47]Ireland MJ, Clough B, Gill K, et al A randomized controlled trial of mindfulness to reduce stress and burnout among intern medical practitioners. Med Teach 2017; 39 (4): 409– 14. 28379084
  37. [48]Isaksson Ro KE, Tyssen R, Hoffart A, et al A three-year cohort study of the relationships between coping, job stress and burnout after a counselling intervention for help-seeking physicians. BMC Public Health 2010; 10 (1): 213. 20423480 PMC2880293
  38. [49]Joseph C. Rebooting the joy of practice = clinical/operational leadership + workflow standardization + technology. In: American Conference on Physician Health. San Francisco, CA; October 12–13, 2017: 29– 30.
  39. [50]Kakarala R, Smith SJ, Barreto E, et al When coaching meets mentoring: impact of incorporating coaching into an existing mentoring program at a community hospital. Cureus 2018; 10 (8): e3138. 30345195 PMC6188216
  40. [52]Kim H, Wiedermann B. Have Accreditation Council for Graduate Medical Education duty hour limits made a difference? A re-examination of resident sleep, mental health, education, and safety seven years later. J Invest Med 2011; 59(3): 630– 1.
  41. [53]Koshy S, Feustel PJ, Hong M, et al Scribes in an ambulatory urology practice: patient and physician satisfaction. J Urol 2010; 184 (1): 258– 62. 20483153
  42. [55]Landrigan CP, Fahrenkopf AM, Lewin D, et al Effects of the accreditation council for graduate medical education duty hour limits on sleep, work hours, and safety. Pediatrics 2008; 122 (2): 250– 8. 18676540
  43. [56]Lapointe R, Bhesania S, Tanner T, et al An innovative approach to improve communication and reduce physician stress and burnout in a university affiliated residency program. J Med Syst 2018; 42 (7): 117. 29808384
  44. [57]Lee MH, Schemmel AJ, Pooler BD, et al Radiology workflow dynamics: how workflow patterns impact radiologist perceptions of workplace satisfaction. Acad Radiol 2017; 24 (4): 483– 7. 27769823
  45. [58]Linzer M, Poplau S, Brown R, et al Do work condition interventions affect quality and errors in primary care? Results from the healthy work place study. J Gen Intern Med 2017; 32 (1): 56– 61. PMC5215160 27612486
  46. [60]Lucas BP, Trick WE, Evans AT, et al Effects of 2-vs 4-week attending physician inpatient rotations on unplanned patient revisits, evaluations by trainees, and attending physician burnout: a randomized trial. JAMA 2012; 308 (21): 2199– 207. 23212497
  47. [63]McCormick BJ, Deal A, Borawski KM, et al Implementation of medical scribes in an academic urology practice: an analysis of productivity, revenue, and satisfaction. World J Urol 2018; 36 (10): 1691– 7. 29637266
  48. [65]Menachemi N, Powers TL, Brooks RG. The role of information technology usage in physician practice satisfaction. Health Care Manage Rev 2009; 34 (4): 364– 71. 19858921
  49. [67]Milenkiewicz RV. The less clicks the better: Improving the documentation workflow process for physicians. In: proceedings of the American Conference on Physician Health; October 12–13, 2017; San Francisco, CA.
  50. [68]Milstein JM, Raingruber BJ, Bennett SH, et al Burnout assessment in house officers: evaluation of an intervention to reduce stress. Med Teach 2009; 31 (4): 338– 41. 19156563
  51. [69]Minichiello V, Hayer S, Gillespie B, et al Developing a Mindfulness Skills-Based Training Program for Resident Physicians. Fam Med 2020; 52 (1): 48– 52. 31914184
  52. [70]Mishra P, Kiang JC, Grant RW. Association of medical scribes in primary care with physician workflow and patient experience. JAMA Intern Med 2018; 178 (11): 1467– 72. 30242380 PMC6248201
  53. [71]Moeller MF. Practice Refresh: A 1-month intervention to rebuild physician efficiency and wellness. In: American Conference on Physician Health; October 12–13, 2017; San Francisco, CA.
  54. [73]Morrow G, Burford B, Carter M, et al Have restricted working hours reduced junior doctors' experience of fatigue? A focus group and telephone interview study. BMJ Open 2014; 4 (3): e004222. PMC3948452 24604482
  55. [75]Payne TH, Alonso WD, Markiel JA, et al Using voice to create inpatient progress notes: effects on note timeliness, quality, and physician satisfaction. JAMIA Open 2018; 1 (2): 218– 26. 31984334 PMC6951907
  56. [76]Pierce RG. A team-based and organizational framework for fostering resilience and well-being in academic hospital medicine. In: proceedings of the American Conference on Physician Health; October 12–13, 2017; San Francisco, CA.
  57. [77]Pozdnyakova A, Laiteerapong N, Volerman A, et al Impact of medical scribes on physician and patient satisfaction in primary care. J Gen Intern Med 2018; 33 (7): 1109– 15. 29700790 PMC6025675
  58. [78]Quenot J-P, Rigaud J-P, Prin S, et al Suffering among carers working in critical care can be reduced by an intensive communication strategy on end-of-life practices. Intensive Care Med 2012; 38 (1): 55– 61. 22127481 PMC3678991
  59. [79]Ripp JA, Bellini L, Fallar R, et al The impact of duty hours restrictions on job burnout in internal medicine residents: a three-institution comparison study. Acad Med 2015; 90 (4): 494– 9. 25607940
  60. [80]Runyan C, Savageau JA, Potts S, et al Impact of a family medicine resident wellness curriculum: a feasibility study. Med Educ Online 2016; 21 (1): 30648. 27282276 PMC4901506
  61. [81]Safavi A, Sienna J, Strang BK, et al Characterizing the initiation, completion, and integration of entrustable professional activity assessments in radiation oncology residency training and clinical workflow: an institutional pilot of competence by design. Radiother Oncol 2019; 139: S85.
  62. [85]Sherlock C, John C. Adaptation Practice: Teaching doctors how to cope with stress, anxiety and depression by developing resilience. Br J Med Pract 2016; 9 (2): a916.
  63. [88]Tucker P, Brown M, Dahlgren A, et al The impact of junior doctors. Scand J Work Environ Health 2010; 36 (6): 458– 65. 20414629
  64. [89]Verweij H, Waumans RC, Smeijers D, et al Mindfulness-based stress reduction for GPs: results of a controlled mixed methods pilot study in Dutch primary care. Br J Gen Pract 2016; 66 (643): e99– 105. 26823271 PMC4723221
  65. [90]Was A. The ideal gas lounge: boosting resident happiness with empowerment and common space improvements. In: proceedings of the International Conference on Physician Health; September 18–20, 2016; Boston, MA.
  66. [91]West CP, Dyrbye LN, Rabatin JT, et al Intervention to promote physician well-being, job satisfaction, and professionalism: a randomized clinical trial. JAMA Intern Med 2014; 174 (4): 527– 33. 24515493
  67. [92]Willard-Grace R. Clinician perception of team support, burnout and “doability” of primary care. In: proceedings of the American Conference on Physician Health; October 12–13, 2017; San Francisco, CA.
  68. [95]Kokkonen EW, Davis SA, Lin HC, et al Use of electronic medical records differs by specialty and office settings. J Am Med Inform Assoc 2013; 20 (e1): e33– 8. 23538721 PMC3715335
  69. [96]Hayt DB, Alexander S. The pros and cons of implementing PACS and speech recognition systems. J Digit Imaging 2001; 14 (3): 149– 57. PMC3607473 11720337
  70. [97]Fleming NS, Becker ER, Culler SD, et al The impact of electronic health records on workflow and financial measures in primary care practices. Health Serv Res 2014; 49 (1, Pt 2): 405– 20. 24359533 PMC3925410
  71. [98]Tai-Seale M, Dillon EC, Yang Y, et al Physicians' well-being linked to in-basket messages generated by algorithms in electronic health records. Health Aff (Millwood) 2019; 38 (7): 1073– 8. 31260371
  72. [101]Pirtle CJ, Reeder RR, Lehmann CU, et al Physician perspectives on training for an EHR implementation. Stud Health Technol Inform 2019; 264: 1318– 22. 31438139
  73. [102]Ratwani R, Fairbanks T, Savage E, et al Mind the gap. a systematic review to identify usability and safety challenges and practices during electronic health record implementation. Appl Clin Inform 2016; 07 (04): 1069– 87. PMC5228144 27847961
  74. [104]National Academies of Sciences, Engineering, and Medicine. Taking Action against Clinician Burnout: A Systems Approach to Professional Well-Being. Washington, DC: The National Academies Press; 2019. 31940160

Cited by

Sorted by citations

Authors
Thomas Craig, K. J., Willis, V. C., Gruen, D., Rhee, K., & Jackson, G. P.
Affiliations
  • Center for AI, Research, and Evaluation, IBM Watson Health, Cambridge, Massachusetts, USA
  • IBM (United States) (US)
ORCID
Venue
Journal of the American Medical Informatics Association
Publisher
Oxford University Press (OUP)
Published
2021-01-19
Volume
28
Issue
5
Pages
985-997
ISSN
  • 1067-5027 (ISSN-L)
  • 1527-974X
DOI
10.1093/jamia/ocaa301
PMC
PMC8068437
OpenAlex
W3121702601
Cited by
123
References
24
Citations by year
2026: 19 · 2025: 30 · 2024: 26 · 2023: 24 · 2022: 13 · 2021: 10 · 2013: 1
FWCI
1.79
Type
journal article
Language
en
Open access
Licence
Locations
  • Journal of the American Medical Informatics Association (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
Funders
IBM Watson Health
Topics
  • Health Sciences › Health Professions › Health Information Management › Electronic Health Records Systems
  • Health Sciences › Health Professions › General Health Professions › Healthcare professionals’ stress and burnout
  • Social Sciences › Psychology › Social Psychology › Technostress in Professional Settings
Keywords
physician burnout, digital health tools, electronic health records, clinical decision support systems, advanced analytics, workflow optimization, usability, documentation burden, job satisfaction, quality improvement, physician training, physician stress
MeSH terms
Burnout, Professional, Computer User Training, Humans, Patient Care Team, Physicians, Workflow, Electronic Health Records, Quality Improvement

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

Are you an author, or do you see a problem with this page? Request a review