Ergonomic considerations loom large as hospitals and other health care organizations rapidly adopt IT tools

Ergonomic experts warn of a flood of repetitive strain injuries among providers

Health care has lagged behind other industries when it comes to leveraging the power of information technology (IT). However, in the race to catch up, which has been accelerated by $20 billion in federal stimulus dollars, ergonomists warn that hospitals and other health care entities are not giving adequate consideration to the potential for IT-related musculoskeletal injuries. In fact, these injuries are already happening, according to Alan Hedge, PhD, CPE, director of the Human Factors and Ergonomics Laboratory at Cornell University in Ithaca, NY.

Hedge recently unveiled the results of a study in which 179 physicians were queried about their computer use and musculoskeletal discomfort. He found that a majority of female doctors and more than 40% of male doctors reported suffering from upper-body repetitive strain ailments on at least a weekly basis.1

"We didn't anticipate that we would already see such high levels of musculoskeletal discomfort, so the alarm bells went off," explains Hedge. While the physicians queried in the study worked in outpatient settings, Hedge notes that the same types of issues are impacting providers in hospitals and EDs. And he stresses that 90% of hospitals are still not intensively using their electronic medical record (EMR) systems. "It is going to get even worse as EMRs get rolled out and people spend even more time using computers as part of their daily work," he says.

Consider how, where technology will be used

Health care organizations are following in the footsteps of most other industries that went through computerization in the 1980s and 1990s, but Hedge says there is little evidence that the people who are leading the health care IT charge have learned from earlier missteps.

"Companies purchased computers en masse, and then in the 1990s we had an epidemic of injuries," he says. "Now we've got that under control because there are ergonomic programs in place. Further, ergonomists are involved with making choices about how technology is going to be used, what furniture is needed to support that, and what work practices you need to ensure that people don't get injured. However, in health care that isn't happening."

Without a rapid change in course, Hedge says health care organizations, including hospitals, EDs, and clinic settings, can expect to see neck, shoulder, arm, and wrist injuries related to poor environmental layouts and improper use of computer devices. And Hedge emphasizes that the current surge in the use of mobile devices comes with its own set of risks.

"A lot of health systems are thinking that they will just give all of their physicians a laptop or a tablet and they can just walk around and capture all of the data, but it is not that simple," says Hedge. "If you don't actually think about how they are going to be using the device, you are just going to create a lot of injury problems for those individuals."

For example, one new phenomenon that Hedge has observed is what he calls "iPad neck." "This develops when people spend a lot of time with their head in a forward inflection," he says. "It puts a lot of strain on the muscles in the back of the neck and shoulders."

Recently, Hedge has been working with people in the ED, and he has found that resorting to laptops or tablets in this setting is particularly problematic for providers. "You don't want them carrying a laptop or tablet or anything like that," he says.

A more workable alternative to consider for the ED, says Hedge, is a cell phone-based system. "With this approach, physicians have their hands free, and data is sent to them via a cell phone that they can easily have in a pocket while they are actually moving around in the space," he says. "There are lots of configurations and information out there. It is really a matter of putting the issue on the radar screen before new systems are implemented."

Too often, IT departments drive the implementation of new systems without proper consideration of how or where the technology will be used, says Hedge.


  1. Hedge A, James T. Gender effects on musculoskeletal symptoms among physician computer users in outpatient diagnostic clinics. Human Factors and Ergonomics Society 2012; 56th Annual Meeting, October 22-26, Boston, MA. 887-891.


Alan Hedge, PhD, CPE, Director, Human Factors and Ergonomics Laboratory, Cornell University, Ithaca, NY. E-mail: