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Particularly since the start of COVID, an increasing number of healthcare professionals work through video screens to deliver care, tend to notes, complete professional training, or for correspondence. A research team led by Donald Hilty published a paper in the Journal of Internet Research detailing their six-stage scoping review of 10 databases of journal articles focused on technology, health care, and fatigue published from 2000 to 2020. Given that the goal of a scoping review is to map the body of literature in a topic area (Arksey & O’Malley, 2005), the research team’s goal for their research was to synthesize clinical, provider, administrative, business, and other workplace data to identify healthy ways that practitioners, in particular, could prevent or minimize problem associated with technology fatigue. As with other scoping reviews, this early work highlights areas of need or gaps for more systematic literature reviews. Despite the preliminary nature of the paper, early suggestions for providers and their employers are offered for ways to improve the user experience and benefit from what has more commonly become known as zoom fatigue research.
The scoping review explored answers to the question: “What is technology-based fatigue and its consequences for providers and patients?” To do so, they searched for articles that addressed the relationship between technology, fatigue, and health care.
Review of “Zoom Fatigue” Research
In reviewing the literature to find related articles, the researchers reported that fatigue is discussed as a “very complex and multidimensional construct” that consistently points to the issue of perceived effort. Even across the discreet fields of cognitive science, exercise physiology, and clinical practice, fatigue accounts for interindividual differences and situational variations, including mental and physical constructs that integrate motivation and emotion.
The case is made that in healthcare, especially in electronic health records (EHRs), fatigue-related problems and excessive workflow steps may negatively impact well-being and contribute to burnout. The study also points to the misnomers in the workplace regarding subjective phrases such as technology fatigue or Zoom fatigue, which suggest that technology causes fatigue. Early studies suggest that this assumption may be false.
Importance of a Focus on User Experience
In many business industries, technology-related challenges are typically met with systematic workflow changes to avoid burnout. However, the researchers reported that in health care, “there appears to be a gap between the system’s perception of processes and users’ or participants’ experiences.” In other words, healthcare technology designers may need to pay more attention to user experience (user X). The good news is that health care is starting to evaluate the longitudinal continua of work engagement and burnout, the development of burnout concerning job demands and resources, and the role of psychosocial working conditions.
Another gap identified in the scoping review is that healthcare organizations have typically approached burnout as an individual issue (e.g., depression) rather than an organizational issue. Key organizational stressors that increase the risk of burnout must be identified at a department or group level. From there, changes can create healthier workplaces and happier workforces.
Technologies considered in the scoping review included synchronous video, telephone, informatics systems, asynchronous wearable sensors, and mobile health devices for health care.
- Concept areas related to provider experience included the following: behavioral, cognitive, emotional, and physical impact; workplace at the individual, clinic, hospital, and system or organizational levels; well-being, burnout, and stress; and perceptions regarding technology.
- The data also included practitioner health, fatigue risk, and burnout manifestations.
Results of Technology Fatigue Study
Of the 4221 potential literature references, 202 were duplicates, and 3837 were deemed irrelevant. A total of 182 studies met all the chosen criteria related to technology, health care, and fatigue. Factors related to the behavioral, emotional, cognitive, and physical impact of the workflow at the individual, hospital, and system or organizational levels were considered. The resulting data represented a spectrum from health to risk. They outline organizational approaches to human factors and technology in health care.
In general, video and electronic health record use have been associated with the following: physical eye fatigue; neck pain; stress; tiredness; and behavioral impacts related to additional effort owing to barriers, trouble with engagement, emotional wear and tear, and exhaustion, cognitive inattention, effort, expecting problems, multitasking and workload, and emotional experiences (e.g., anger, irritability, stress, and concern about well-being).
Helpful interventions developed in other fields are beginning to appear in healthcare. They include changes to workplace culture, focusing on well-being and prevention of burnout. Specific focus areas include clinical care, human factors, training, professional development, workflow, and administration. The concept of burnout is also changing, with a shift toward burnout as being seen as an occupational phenomenon rather than only as an individual medical issue (e.g., depression). Therefore, health care and administrative resources should move beyond the individual (e.g., Family and Medical Leave Act) to focus on structural, cultural, and social educational factors, including professional training.
Conclusion: Negative User Experience
In concluding their paper, the research team stated:
Health care systems need to evaluate the impact of technology in accordance with the Quadruple Aim to support providers’ well-being and prevent workload burden, fatigue, and burnout. Implementation and effectiveness approaches and a multilevel approach with objective measures for clinical, human factors, training, professional development, and administrative workflow are suggested. This requires institutional strategies and competencies to integrate health care quality, technology and well-being outcomes.
In short, software developers and users are encouraged to minimize technology fatigue by testing software for user experience before requiring professionals to engage with the software throughout their workday. Just as driver fatigue can be minimized by good ergonomic design, technology fatigue may be minimized by more careful attention to user experience. Simply stated, inadequate software design may be the root cause of technology fatigue rather than the act of using technology. Continued “zoom fatigue research” will be reported by Telehealth.org as it unfolds.