Electronic Health Record-Related Technostress
DOI:
https://doi.org/10.30953/thmt.v11.681Keywords:
burnout, digital transformation , electronic health records, job burnout, technostressAbstract
Background: Opportunities and challenges accompany the ongoing digital transformation in healthcare. These are exemplified by the extensive use of electronic health records (EHR) and digitalization of national health systems. EHRs enhance patient care and information accessibility but can also lead to technostress (i.e. stress associated with technology use). With a focus on job burnout, the authors investigate the effects of the dimensions of technostress—techno-complexity, techno-invasion, techno-overload, and techno-uncertainty—on work engagement among healthcare personnel using EHR.
Methods: A quantitative, cross-sectional design was employed to investigate the relationships among technostress, burnout, and work engagement among healthcare professionals using EHRs. Data were collected from 213 healthcare workers in Indonesia. Partial least squares–structural equation modeling was applied to assess the direct effects of technostress dimensions and indirect effects as mediated by job burnout.
Results: Techno-overload unexpectedly lowers burnout, indicating an adaptive response, while techno-complexity, techno-invasion, and techno-uncertainty increase it. Burnout significantly reduces work engagement, confirming its mediating effect between technostress and work engagement.
Conclusion: Different aspects of technostress exert a range of effects on healthcare workers, with some factors reducing burnout and others increasing it based on organizational support and skill levels. Enhancing digital support, including targeted training, and simplifying systems are essential to reduce technostress and improve workforce engagement in digital healthcare environments.
Downloads
References
1. Modi S, Feldman SS. The Value of Electronic Health Records Since the Health Information Technology for Economic and Clinical Health Act: Systematic Review. JMIR Med Inform. 2022 Sep 27;10(9):e37283.
2. Hossain MdK, Sutanto J, Handayani PW, Haryanto AA, Bhowmik J, Frings-Hessami V. An exploratory study of electronic medical record implementation and recordkeeping culture: the case of hospitals in Indonesia. BMC Health Serv Res. 2025 Feb 14;25(1):249.
3. Amalia N, Rustam MZA, Rosarini A, Wijayanti DR, Riestiyowati MA. The Implementation of Electronic Medical Record (EMR) in The Development Health Care System in Indonesia. IJALSR [Internet]. 2021 Jul 21 [cited 2025 Dec 2];4(3). Available from: http://www.ijalsr.org/index.php/journal/article/view/128
4. Bernburg M, Tell A, Groneberg DA, Mache S. Digital stressors and resources perceived by emergency physicians and associations to their digital stress perception, mental health, job satisfaction and work engagement. BMC Emerg Med. 2024 Feb 27;24(1):31.
5. Ragu-Nathan TS, Tarafdar M, Ragu-Nathan BS, Tu Q. The Consequences of Technostress for End Users in Organizations: Conceptual Development and Empirical Validation. Information Systems Research. 2008 Dec;19(4):417–33.
6. Vargas-Benítez MÁ, Izquierdo-Espín FJ, Castro-Martínez N, Gómez-Urquiza JL, Albendín-García L, Velando-Soriano A, et al. Burnout syndrome and work engagement in nursing staff: a systematic review and meta-analysis. Front Med. 2023 Jul 17;10:1125133.
7. Golz C, Peter KA, Müller TJ, Mutschler J, Zwakhalen SMG, Hahn S. Technostress and Digital Competence Among Health Professionals in Swiss Psychiatric Hospitals: Cross-sectional Study. JMIR Ment Health. 2021 Nov 4;8(11):e31408.
8. Rao S, Ferris TG, Hidrue MK, Lehrhoff SR, Lenz S, Heffernan J, et al. Physician Burnout, Engagement and Career Satisfaction in a Large Academic Medical Practice. Clin Med Res. 2020 Mar;18(1):3–10.
9. Bail C, Harth V, Mache S. Digitalization in Urology—A Multimethod Study of the Relationships between Physicians’ Technostress, Burnout, Work Engagement and Job Satisfaction. Healthcare. 2023 Aug 10;11(16):2255.
10. Edú-Valsania S, Laguía A, Moriano JA. Burnout: A Review of Theory and Measurement. IJERPH. 2022 Feb 4;19(3):1780.
11. Bakker AB. The social psychology of work engagement: state of the field. CDI. 2022 Feb 21;27(1):36–53.
12. Babiker M, Merisalu E, Roja Z. Exploration of the Association between Technostress and Burnout among Healthcare Professionals. IJSRC. 2024 Mar 15;12(3):29–41.
13. Ficapal-Cusí P, Torrent-Sellens J, Yuguero O. Technostress among healthcare professionals in Spain: a cross-sectional survey on the impact of digital health tools. BMJ Open. 2025 Sep;15(9):e103783.
14. Tajirian T, Stergiopoulos V, Strudwick G, Sequeira L, Sanches M, Kemp J, et al. The Influence of Electronic Health Record Use on Physician Burnout: Cross-Sectional Survey. J Med Internet Res. 2020 Jul 15;22(7):e19274.
15. Budd J. Burnout Related to Electronic Health Record Use in Primary Care. J Prim Care Community Health. 2023 Jan;14:21501319231166921.
16. Bernales-Turpo D, Quispe-Velasquez R, Flores-Ticona D, Saintila J, Ruiz Mamani PG, Huancahuire-Vega S, et al. Burnout, Professional Self-Efficacy, and Life Satisfaction as Predictors of Job Performance in Health Care Workers: The Mediating Role of Work Engagement. J Prim Care Community Health. 2022 Jan;13:21501319221101845.
17. Munn LT, O’Connell N, Huffman C, McDonald S, Gibbs M, Miller C, et al. Job-Related Factors Associated with Burnout and Work Engagement in Emergency Nurses: Evidence to Inform Systems-Focused Interventions. Journal of Emergency Nursing. 2025 Mar;51(2):249–60.
18. Chan AO, Chan YH, Chuang KP, Ng JS, Neo PS. Addressing physician quality of life: understanding the relationship between burnout, work engagement, compassion fatigue and satisfaction. JHA. 2015 Aug 23;4(6):46.
19. Alexias G, Papandreopoulou M, Togas C. Work Engagement and Burnout in a Private Healthcare Unit in Greece. IJERPH. 2024 Jan 25;21(2):130.
20. Perepelkin J, Wilson GA. The Mediating Role of Burnout in the Anxiety and Work Engagement Relationship. Journal of Health Management. 2023 Dec;25(4):860–9.
21. Widhianingtanti LT, Luijtelaar GV. The Maslach-Trisni Burnout Inventory: Adaptation for Indonesia. JP3I. 2022 May 19;11(1):1–21.
22. Hapsari EA, Rohmatullayaly EN, Widayati KA. Technostress and Sleep Quality among University Students in Indonesia: A Cross-sectional Study. Asian Journal of Social Health and Behavior. 2024 Oct;7(4):197–202.
23. Schaufeli W, Bakker A. Utrecht Work Engagement Scale: Preliminary manual. Utrecht University: Occupational Health Psychology Unit;
24. Maslach C, Jackson S, Leiter M. Maslach Burnout Inventory manual (3rd ed.). Palo Alto: CA: Consulting Psychologists Press; 1996.
25. Hair JF, Hult GTM, Ringle CM, Sarstedt M, Danks NP, Ray S. Partial Least Squares Structural Equation Modeling (PLS-SEM) Using R: A Workbook [Internet]. Cham: Springer International Publishing; 2021 [cited 2025 Dec 2]. (Classroom Companion: Business). Available from: https://link.springer.com/10.1007/978-3-030-80519-7
26. Hair JF, Risher JJ, Sarstedt M, Ringle CM. When to use and how to report the results of PLS-SEM. EBR. 2019 Jan 14;31(1):2–24.
27. Muhamad NA, Ma’amor NH, Jamalluddin NH, Rosli IA, Leman FN, Tengku Baharudin Shah TPN, et al. Technostress and its associated factors: Burnout and fatigue among Malaysian healthcare workers (HCWs) in state hospitals. Alamri MS, editor. PLoS ONE. 2025 Mar 17;20(3):e0319506.
28. Issa H, Jaber J, Lakkis H. Navigating AI unpredictability: Exploring technostress in AI-powered healthcare systems. Technological Forecasting and Social Change. 2024 May;202:123311.
29. Kaltenegger HC, Becker L, Rohleder N, Nowak D, Quartucci C, Weigl M. Associations of technostressors at work with burnout symptoms and chronic low-grade inflammation: a cross-sectional analysis in hospital employees. Int Arch Occup Environ Health. 2023 Aug;96(6):839–56.
30. Wirth T, Kräft J, Marquardt B, Harth V, Mache S. Indicators of technostress, their association with burnout and the moderating role of support offers among nurses in German hospitals: a cross-sectional study. BMJ Open. 2024 Jul;14(7):e085705.
31. Thanasrivanitchai J, Torasamphan T. The Effect of Technostress to Employee’s Job Burnout in Organization Within Thailand. In: 2024 Portland International Conference on Management of Engineering and Technology (PICMET) [Internet]. Portland, OR, USA: IEEE; 2024 [cited 2025 Dec 3]. p. 1–6. Available from: https://ieeexplore.ieee.org/document/10653255/
32. Shaban M, Ezzelregal Abdelgawad M, Mohamed Elsayed S, Mohamed Abdallah HM. The mediating role of emotional intelligence in the relationship between technostress and burnout prevention among critical care nurses a structural equation modelling approach. BMC Nurs. 2025 Mar 6;24(1):255.
33. Harris DA, Haskell J, Cooper E, Crouse N, Gardner R. Estimating the association between burnout and electronic health record-related stress among advanced practice registered nurses. Applied Nursing Research. 2018 Oct;43:36–41.
34. Kopuz K, Turgut M, Aydın G. Technostress among nurses: boon or bane? The moderated mediation model. BMC Nurs. 2025 Aug 20;24(1):1092.
35. Sanjeeva Kumar P. TECHNOSTRESS: A comprehensive literature review on dimensions, impacts, and management strategies. Computers in Human Behavior Reports. 2024 Dec;16:100475.
36. Tarafdar M, Cooper CL, Stich J. The technostress trifecta ‐ techno eustress, techno distress and design: Theoretical directions and an agenda for research. Information Systems Journal. 2019 Jan;29(1):6–42.
37. Kaihlanen AM, Gluschkoff K, Hyppönen H, Kaipio J, Puttonen S, Vehko T, et al. The Associations of Electronic Health Record Usability and User Age With Stress and Cognitive Failures Among Finnish Registered Nurses: Cross-Sectional Study. JMIR Med Inform. 2020 Nov 18;8(11):e23623.
38. Hafstad MD, Ebrahimi OV, Fostervold KI. The Dialectical Relationship Between Burnout and Work Engagement: A Network Approach. Stress and Health. 2025 Apr;41(2):e3514.
39. Kidayi MA, Stephano EE, Sellah ZJ, Mtoro MJ, Min Y. Nursing informatics competence and its associated factors among nurses in Tanzania: a cross-sectional study. BMC Nurs. 2025 Aug 18;24(1):1077.
40. Keshavarz H, Saeidnia HR, Wang T. Navigating technostress: a deep dive into health practitioners’ technological challenges in hospital settings. BMC Health Serv Res. 2025 Jan 3;25(1):18.
41. Kaihlanen AM, Gluschkoff K, Laukka E, Heponiemi T. The information system stress, informatics competence and well-being of newly graduated and experienced nurses: a cross-sectional study. BMC Health Serv Res. 2021 Dec;21(1):1096.
42. Würtenberger A, Groneberg DA, Mache S. Digital stress perception and associations with work- and health-related outcomes among general practitioners in Germany: a quantitative study. BMC Health Serv Res. 2025 Apr 11;25(1):535.
43. Mohan V, Garrison C, Gold JA. Using a New Model of Electronic Health Record Training to Reduce Physician Burnout: A Plan for Action. JMIR Med Inform. 2021 Sep 20;9(9):e29374.
44. Stadin M, Nordin M, Fransson EI, Broström A. Healthcare managers’ experiences of technostress and the actions they take to handle it – a critical incident analysis. BMC Med Inform Decis Mak. 2020 Dec;20(1):244.
Published
How to Cite
Issue
Section
License
Copyright (c) 2026 Angellica Subianto Tan, Steffi Putri Erlan, Yohana F. Cahya Palupi Meilani
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
Authors retain copyright of their work, with first publication rights granted to Telehealth and Medicine Today (THMT).
THMT is published under a Creative Commons Attribution-NonCommercial 4.0 International License.
