J Am Med Inform Assoc doi:10.1136/amiajnl-2013-001875
  • Research and applications

Electronic medical records and physician stress in primary care: results from the MEMO Study

  1. Mark Linzer8
  1. 1Internal Medicine, University of Kansas Medical Center, Kansas City, Kansas, USA
  2. 2University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin, USA
  3. 3University of Wisconsin-Madison School of Nursing, Madison, Wisconsin, USA
  4. 4Northwestern University, Chicago, Illinois, USA
  5. 5University of Alabama, Tuscaloosa, Alabama, USA
  6. 6New York University, New York, New York, USA
  7. 7Mayo Clinic College of Medicine, Rochester, Minnesota, USA
  8. 8Hennepin County Medical Center, Minneapolis, Minnesota, USA
  1. Correspondence to Dr Stewart Babbott, Internal Medicine, University of Kansas Medical Center, 6040 Delp, MS 1020, 3901 Rainbow Boulevard, Kansas City, KS 66160, USA; sbabbott{at}
  • Received 12 April 2013
  • Revised 13 August 2013
  • Accepted 14 August 2013
  • Published Online First 4 September 2013


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.

Design and participants 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.

Main measures 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).

Key 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.

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