Effect of Electronic Health Record Modernization on Burnout Among VA Frontline Clinicians: A Quasi-Experimental Study

To measure the impact of electronic health record (EHR) transition on burnout among Veterans Health Administration (VA) frontline clinicians using pseudorandom variation from staggered EHR implementations across VA sites.

Employing a quasi-experimental design, we studied 140 VA medical center sites nationwide (including five sites that implemented the new EHR from 2019 to 2023). Explanatory measures included year, VA transition site (grouped into three cohorts by transition timing), and their interaction. Our outcome measure encapsulated two dimensions of burnout-emotional exhaustion and depersonalization (symptoms > once per week indicated burnout).

Using secondary data from the 2019 to 2023 VA All Employee Survey, we aggregated survey responses on the medical-site level by year and respondent characteristics. Our analytic sample included 12,155 aggregated observations. We used a difference-in-difference approach to compare pre-post changes in burnout between VA sites implementing and not implementing the new EHR. Where available, we reported post-transition treatment effects in the short term, medium term, and long term, relative to EHR implementation.

Unadjusted burnout from 2019 to 2023 was 36.9% for Cohort 1, 33.0% for Cohort 2, 37.0% for Cohort 3, and 33.2% for non-transition sites. In adjusted analyses, burnout for Cohort 1 increased 4.8 percentage points (p < 0.001) in the medium term; differences in burnout dissipated in the long term. For Cohort 2, we detected a 1 percentage point increase in burnout (p = 0.004) in the short term and a 1.5 percentage point decrease (p = 0.013) in the medium term. For Cohort 3, burnout increased 3.3 percentage points (p < 0.001) in the medium term.

The impact of EHR transition on burnout differed across deployment sites and post-transition periods but was mild overall. Future research is needed to understand contextual and implementation process differences between sites that may explain differential effects and offer learnings to ensure a high-functioning health workforce during EHR transition.