Until recently, most doctors created their own workflows and used only technology they were comfortable with. But with the implementation of the 2009 Health Information Technology for Economic and Clinical Health Act (HITECH Act) to stimulate adoption of EHRs, many physicians are finding things a bit too stressful.
In fact, a new study in Mayo Clinic Proceedings showed that physicians who are uncomfortable using EHRs are more likely to reduce hours or leave the profession.
The research showed that while EHRs hold great promise for improving the quality and enhancing the coordination of care, in their current form and implementation they have created numerous unintended negative consequences including reduced efficiency, increased clerical burden, and increased risk of physician burnout.
Tom Davis, MD, who practiced primary care medicine for almost 25 years in the St. Louis area, says the main reason he left a successful practice was the EHR, citing its use, the ethics and the burden.
“I had 3,000 patients, many I’ve known for a quarter century, a few hundred of which I delivered, all immensely valuable relationships—and all burned to the ground mostly because of the burdens of the HITECH Act,” he says. “The demands of data entry, the use of that data to direct care and my overall uncertainty about how medical data was used in aggregate all helped poison the well from which my passion for serving my patients was drawn.”
He believes that the information collected through the EHR is being used (at least in aggregate) for purposes other than the direct benefit of the individual patient so it would be unethical for him to represent otherwise to the patient. As far as the burden, he notes he spent about four minutes of keyboard time for every minute of face-to-face time with a patient.
Ramin Javahery, MD, chief of adult and pediatric neurosurgery at Long Beach Memorial Medical Center in Long Beach, Calif., says there are obvious financial pressures that drive physicians out of independent practice into a larger corporate structure, but the changes brought about by EHRs are also driving older doctors to retire rather than deal with the costs or increased work.
“Younger physicians who are comfortable with typing, computers, and the truncated patient interactions generated by EHRs do not resist its presence,” he says. “Older physicians, however, are more likely to lack those comforts. When faced with a less comfortable work environment, they choose to retire, especially since many have saved enough to be comfortable financially.”
Kevin Gebke, MD, a primary care and sports medicine practitioner at Indiana University Health in Indianapolis, says the issue is not fear, but a matter of dramatic workflow change.
“EHRs were not designed by practicing clinicians and are not intuitive regarding the different processes that take place during a patient encounter,” he says. “Physicians must often choose between communicating with the patient and navigating within the records to enter or view relevant data. That can fragment care during a
His experience with EHRs is that they have slowed his workflow, causing a significant decrease in productivity.
“Spread this decreased capacity to see patients across the country and we then have a magnified shortage of primary care providers,” Gebke says.
Things are improving
Munzoor Shaikh, MBA, director of consulting firm West Monroe’s healthcare and life sciences practice in Chicago, says that while some doctors are leaving medicine due to technology learning curves, the industry is past the EHR implementation phase and has entered an optimization phase where the user experience on the physician side should be improving.
“Those who have more patience than others have stuck around; hopefully this optimization phase will save some more doctors from leaving,” he says.