title: Electronic medical records and physician stress in primary care: results from the MEMO Study.
abstract: BACKGROUND
  Little has been written about physician stress that may be associated with electronic medical records (EMR).
  
  
  OBJECTIVE
  We assessed relationships between the number of EMR functions, primary care work conditions, and physician satisfaction, stress and burnout.
  
  
  METHODS
  379 primary care physicians and 92 managers at 92 clinics from New York City and the upper Midwest participating in the 2001-5 Minimizing Error, Maximizing Outcome (MEMO) Study. A latent class analysis identified clusters of physicians within clinics with low, medium and high EMR functions.
  
  
  METHODS
  We assessed physician-reported stress, burnout, satisfaction, and intent to leave the practice, and predictors including time pressure during visits. We used a two-level regression model to estimate the mean response for each physician cluster to each outcome, adjusting for physician age, sex, specialty, work hours and years using the EMR. Effect sizes (ES) of these relationships were considered small (0.14), moderate (0.39), and large (0.61).
  
  
  RESULTS
  Compared to the low EMR cluster, physicians in the moderate EMR cluster reported more stress (ES 0.35, p=0.03) and lower satisfaction (ES -0.45, p=0.006). Physicians in the high EMR cluster indicated lower satisfaction than low EMR cluster physicians (ES -0.39, p=0.01). Time pressure was associated with significantly more burnout, dissatisfaction and intent to leave only within the high EMR cluster.
  
  
  CONCLUSIONS
  Stress may rise for physicians with a moderate number of EMR functions. Time pressure was associated with poor physician outcomes mainly in the high EMR cluster. Work redesign may address these stressors.
authors.affiliation: Internal Medicine, University of Kansas Medical Center, Kansas City, Kansas, USA.
authors.forename: Stewart
authors.initials: S
authors.lastname: Babbott
authors.forename: Linda Baier
authors.initials: LB
authors.lastname: Manwell
authors.forename: Roger
authors.initials: R
authors.lastname: Brown
authors.forename: Enid
authors.initials: E
authors.lastname: Montague
authors.forename: Eric
authors.initials: E
authors.lastname: Williams
authors.forename: Mark
authors.initials: M
authors.lastname: Schwartz
authors.forename: Erik
authors.initials: E
authors.lastname: Hess
authors.forename: Mark
authors.initials: M
authors.lastname: Linzer
mesh_terms: D000328:Adult; D002055:Burnout, Professional / Q000209:etiology; D057286:Electronic Health Records; D005260:Female; D006801:Humans; D007588:Job Satisfaction; D008297:Male; D008875:Middle Aged; D015279:Organizational Culture; D010821:Physicians, Family / Q000523:psychology; D058007:Physicians, Primary Care / Q000523:psychology*; D011320:Primary Health Care / Q000458:organization & administration; D013315:Stress, Psychological / Q000453:epidemiology / Q000209:etiology*
keywords: electronic medical records; outpatient clinics; physicians; primary care; stress, psychological