Physician burnout is a significant problem in the United States today. One study has suggested that over 50% of physicians have experienced at least one symptom of burnout; alarmingly, the authors also noted that the frequency of burnout increased by 10% in just three years (2011-2014) [1].

The risk of burnout has only intensified because of the additional stress on physicians caused by the COVID-19 pandemic [2], further underscoring the urgent need to find a way to mitigate this professional crisis.

While the etiology is multifactorial, the electronic health record (EHR) has been strongly implicated in physician burnout [3], particularly because physicians spend a substantial proportion of their workday using the EHR. For example, primary care physicians spend more than half of their workday (nearly 6 hours) interacting with the EHR, both during and after regular patient care hours [4].

Commercial EHRs tend to be large, complex, clunky software that are often not praised for their ease of use. Needless to say, physician satisfaction with their EHR is generally low [5]. As many as 70% of EHR users have reported health information technology–related stress and a substantial proportion of physicians are unable to complete many of their EHR-related tasks when at work. Therefore, they end up spending an excessive amount of time [6] catching up on EHR “paperwork” (the irony of using this word in the context of the EHR is not lost on us) at home. The implications for this are significant: physicians who reported moderately high or excessive time spent on EHRs at home had almost twice the risk of burnout [7].

The emphasis on clinical workflow efficiency (a phenomenon that has seen a sharp increase in attention after the advent of the EHR) coupled with the increasing complexity of the medical record has led to an exponential increase in the amount of patient data recorded in the EHR. Not only do primary care physicians spend half their working day at the computer, about half their time in the EHR is spent engaging in clerical and administrative tasks (eg, documentation, order entry, billing, and coding) and about a quarter of the remainder of their EHR time is spent managing their inbox [8]. The clerical burden associated with EHR use, a consequence of compliance and regulatory requirements, may play a key role in promoting physician burnout [9,10]. The amount of EHR time may increase with the inclusion of more genomic and consumer data into the patient record. Combine this with a rapid rise in the use of patient portals due to the COVID-19 pandemic and the result is a “perfect storm” of excessive data and cognitive burden [11]. Some of this can be mitigated by reducing administrative requirements using regulation directed from the federal level and optimizing clinical workflows. However, the continual increase in the information needs of physicians highlights the importance of ensuring that physicians are effectively trained in how to use the EHR to effectively and efficiently perform these tasks, thus minimizing pain points [12,13].

One primary issue is that current models of EHR training are limited. As EHR use has become ubiquitous in health care, organizations have typically focused on providing initial training on EHR use to clinicians. These initial training offerings typically focus on basic EHR use but do not provide opportunities to gain workflow proficiency. One study has suggested that 43% of clinician users considered initial EHR training to be “less than adequate” and almost 95% felt that it could be improved [14].

Once they have completed basic EHR training, physicians then learn EHR skills on the job and typically improve their EHR use by the process of trial and error while interacting with the system interface, by gleaning nuggets of best practices from their peers, or by gaining additional insight when there is a significant system update that typically necessitates rolling out a new wave of EHR training. This is not only inefficient, but also offers no certainty that what is gleaned in this on-the-job fashion is truly the best way to use the system.

Additionally, current EHR training models are typically not tailored to a physician’s unique workflow and information needs—in essence, the type of information, the way information is retrieved, and the specifics of documentation are different for, for example, an ambulatory obstetrician, a medical intensivist, and a trauma surgeon. The current model of EHR training, relying on a one-size-fits-all approach, is unable to accommodate for these variations in clinical workflows between specialties and locations.

Areas for potential interventions include the following: (1) improving EHR-related training, (2) remodeling clinical workflows, and (3) redesigning the EHR to better reflect optimal workflows. In this paper, we present a viable model for transforming EHR education.

Some organizations have attempted to mitigate gaps in EHR training by organizing additional sessions to optimize clinician use of the EHR, either through refresher courses or retreats [15]. One organization has combined this with a structured, rapid assessment of workflow patterns and designed training that is informed by clinician feedback [16]. Others have used one-on-one or group proficiency training to improve self-reported EHR efficiency [10,17], while another organization described an individualized learning plan for physicians to improve their use of the EHR [18].

However, these solutions are, in essence, rescue therapies designed to “undo” the damage of poor initial training. They are also time intensive and for the most part focus on one specific domain, usually centered around improving efficiency in documentation or optimizing charge capture, and do not encompass the full spectrum of EHR activities encountered in a physician’s specialty and workflow.

The addition of an instructional designer to the training team greatly improves the quality of learning materials, particularly those that are offered asynchronously. We are obtaining continuing medical education and Maintenance of Certification credits for our EHR training, which promote compliance.

Importation of simulation cases into the training environment can be challenging, and the value of a team member who is trained in data importation into the EHR is critical to the success of any simulation-based training program.

COVID-19 has led to the virtualization of most nonclinical activities conducted by health care organizations, including EHR training. We believe that some forms of simulation-based training can only be provided in the face-to-face setting.

Finally, securing organizational commitment and allocation of adequate resources are often the most challenging elements in developing and deploying a comprehensive EHR training plan, but we believe these are also the most critical factors to ensure success.