Electronic health records (EHRs) promised to revolutionize healthcare delivery. In some respects, they have. But for physicians deluged by patients, EHRs have yet to fulfill their lofty promises and, in many cases, have added considerable strain to the daily workload of physicians. In this article, physicians discuss with Medical Economics how EHRs should—and must—improve to reach their potential.
Jeffrey Pearson, DO, a family physician practicing in a 70-doctor group in the San Diego area, regards himself as a tech “geek.” He has used two different EHRs over a period of six years, and he says he received adequate training on his current system. Yet he is frustrated because, except in the simplest encounters, he can’t finish his EHR documentation by the end of each visit.
“I saw patients all morning, and some were fairly complicated, and with an EHR there’s no time to do your full charting when you’re in the room,” he says. “All the patients get backed up if you do. So I’ll probably take two or three hours at home to get caught up on charting, and that certainly isn’t reimbursed.”
Many other doctors are similarly frustrated. A recent high-profile RAND Corp. survey found that for many physicians, “the current state of EHR technology significantly worsened professional satisfaction in multiple ways.” Among the aspects of EHRs that displeased doctors were “poor usability, time-consuming data entry, interference with face-to-face patient care, inefficient and less fulfilling work content, inability to exchange health information, and degradation of clinical documentation.”
On the other hand, only 20% of the survey’s respondents said they wanted to go back to paper charts, and few physicians actually do that, observers say.
“No way would I go back to paper,” declares internist Yul Ejnes, MD, MACP, who belongs to an 80-doctor group in Providence, R.I., and is a former board chair of the American College of Physicians (ACP). “I think EHRs are our future, and we went electronic in 2006, before the feds were paying for it, because we saw value in it. But a lot of our needs have changed, and the current products don’t meet them. The issue of the user interface needs to be addressed.”
“To most doctors, it’s apparent that EHRs are better than paper,” says Robert Wachter, MD, a professor of medicine at the University of California, San Francisco. “But it’s also clear to many doctors that there are losses they’ve seen as they’ve gone digital, and the systems need to be and can be much better.”
Not all of the problems can be traced to poor EHR design, experts and physicians say. Regulatory compliance and billing needs account for some of the difficulties that physicians encounter when they use EHRs. But there’s a general sense that EHR vendors could do more to deliver innovative applications that meet users’ needs and help them improve quality, safety and efficiency.
Many doctors are disappointed that EHRs have not fulfilled more of their promise in these areas. But 54% of physicians believe that their systems have helped them improve quality, according to an exclusive Medical Economics survey, and some studies support that perception.
“There’s some reasonably persuasive evidence that health IT has improved quality and safety—although there certainly are examples of new safety and quality problems that have emerged because of technology,” says Wachter, author of “The Digital Doctor: Hope, Hype and Harm at the Dawn of Medicine’s Computer Age.”
Where the promise of EHRs has been largely unrealized, he says, is in efficiency. A RAND study conducted in 2005 predicted health IT would save upwards of $80 billion a year, he recalls, “but those savings have been elusive. When you look at studies that ask whether computerization has saved money, the answer mostly is no. And most doctors will tell you they’ve become less efficient in their practice since adopting EHRs.”
Mark Anderson, FHIMSS, a health IT consultant in Montgomery, Texas, points out that most physicians never see more patients than they did before they got EHRs. “The best we’ll get back to is neutral, which would be great. There will never be any productivity gains for the doctors, although there are time savings for nurses.”
Some physicians do find that EHRs make them more efficient. For example, Edward Gold, MD, an internist in Emerson, New Jersey, says his EHR makes it easier to locate patient information and to place and track orders. Ejnes, similarly, says his medication and problem lists are far more up-to-date than they were on paper.
But the general view is that the current EHRs are clunky, cumbersome, and difficult to use, regardless of how tech-savvy their users are. What follows is a dissection of what’s wrong with EHRs and what might be done to improve them.