Hospitalists spend a lot of time on screens as a result of a high volume of electronic health record (EHR) messages as well as low-value text alerts and increasingly frequent portal messages, all of which take away from time spent with patients.

This growing digital burden among hospitalists can contribute to stress and job dissatisfaction. Research has also shown that use of EHRs and the digital burden that they cause is directly associated with physician burnout, a growing problem among hospitalists.

Why Hospitalists Are Particularly Vulnerable

The nature of hospital medicine is about being the “captain of the ship,” meaning that hospitalists are often the first point of contact, as opposed to a specialist who might be managing one particular aspect of care and, therefore, receiving messages only regarding this particular issue. A hospitalist, on the other hand, will receive messages about all aspects of care at all hours of the day and night.

Additionally, the transition to Health Insurance Portability and Accountability Act-compliant text alert systems has caused additional digital fatigue particularly in hospitalists who no longer use pagers. Text alerts have changed the face of hospital communication, said Jennifer Caputo-Seidler, MD, a hospitalist and assistant professor of medicine at the University of South Florida in Tampa.

“In our personal life, we’re used to communicating via texts and DMs [direct messages] on social media, where instant response is expected, and as a result, this need for response has creeped into healthcare,” said Caputo-Seidler.

The volume of messages that hospitalists receive daily has also increased exponentially since the transition away from pagers, she added. “Pagers were usually reserved for issues that were urgent and time sensitive, but it’s just so much easier to shoot off a text,” said Caputo-Seidler.

Patient Acuity and Seriousness Leads to More Messages

The patient population that a hospitalist is working with is often more acutely ill, said Areeba Kara, MD, a hospitalist and interim division chief of General Internal Medicine and Geriatrics at the Indiana University School of Medicine in Indianapolis.

Managing patients with more serious and acute illnesses means physicians are more likely to spend additional time on the EHR viewing medical records, managing orders, and monitoring patient progress.

The hospitalist may also be getting additional messages from nurses, pharmacists, discharge planners, and auxiliary staff, and many of the messages that they receive have nothing to do with patient welfare. The EHR and the clinical note have gone from being a way to communicate what’s going on with the patient to all sorts of other aspects unrelated to care.

“More and more hospitalists aren’t just taking care of patients; they’re also meeting regulatory, quality, billing, and coding expectations through the electronic medical record,” said Kara. “The more that gets piled on, the more a physician ends up interacting with the EHR and the less time is spent with patients.”

While some amount of interacting with the EHR is needed to make sure that physicians have thoroughly reviewed patient records, the data are yet to show us that ideal amount. Kara added that there needs to be research done to see what amount of time spent on the EHR is necessary for the best patient outcomes.

Hospitalists are often drawn to hospital medicine because they want to care for patients, which can lead to a level of dissatisfaction and, later, burnout when those expectations aren’t met because of bloated time being spent on the EHR. What’s more, this is a specialty that already has a high degree of burnout.

The Society of Hospital Medicine’s Hospital Medicine Workforce Experience Report surveyed 900 hospitalists and found that nearly half of them reported being burned out and less than a quarter felt professionally satisfied.

“If most of your time is spent interacting with the EHR and not the patient, it would be worrisome if physicians didn’t experience some level of dissatisfaction,” said Kara. “This is not a trend that we should be normalizing.”

How to Reduce the Digital Burden

The digital burden placed on hospitalists is problematic because much of this time doesn’t end up being compensated. It’s work that not only takes away from being with patients but also adds to a physician’s workload.

When a physician starts at a new hospital system, teaching that hospitalist the ins and outs of the EHR will help them know how to use the platform efficiently and go a long way toward ensuring they’re not spending extra unpaid time trying to figure it out later, said Caputo-Seidler.

Additionally, eliminating messages that aren’t directly related to the care that hospitalists are providing to patients can help reduce their digital workload. The financial mission of the hospital is important, said Kara, but it needs to be separated from clinical messages within the EHR. She said deploying AI to extract the information that’s leading to a lot of redundancy on the EHR could also be helpful.

“Physicians should not be the first person receiving these lower value alerts,” said Manajyoti Yadav, MD, a hospitalist and associate professor of clinical medicine at the University of Illinois College of Medicine Peoria. “They should go to the nurses or staff and then get filtered up the chain of command.”

This might mean adding an employee to deal with messages and direct them to the appropriate source as well as processing after-hours inbox messages. In the case of larger hospital systems, having a dedicated staff person to receive regional transfer calls instead of the on-call hospitalist can also go a long way in reducing their digital burden.

What’s more, protecting time during the day means a hospitalist can have uninterrupted time for cognitive processing to deal with more complex decision-making. It can also help avoid mistakes and increase job satisfaction, said Yadav.

He added that we’re just learning about the consequences that digital fatigue can have on hospitalists because these systems are constantly growing in complexity and we need to be thinking clearly about how to deal with these effects and their impact on the workforce and on patient care.

“The research is just beginning to unravel the profound effects that digital fatigue is having on our physicians,” said Yadav.

Caputo-Seidler, Kara, and Yadav reported no relevant disclosures.