EHRs continue to hinder physician job satisfaction

Physicians’ rocky relationships with their electronic health records (EHR) systems seem to trump other professional issues that lead to job satisfaction, according to a survey of physicians conducted by the RAND Corporation sponsored by the American Medical Association (AMA).

The survey looked at overall job satisfaction for physicians in the areas of autonomy, leadership, fairness, work quantity, staff, pay, liability concerns and healthcare reform, but had to be retooled because physicians kept mentioning issues with their EHR systems. The survey’s authors found that EHR systems “represent a unique and vexing challenge to physician professional satisfaction. Few other service industries are exposed to universal and substantial incentives to adopt such a specific, highly regulated form of technology, one that our findings suggest has not yet matured.”

Only 35% of physicians say that EHRs improve their job satisfaction, and 31% are overwhelmed by the volume of electronic messages received in the office. Sixty-one percent of physicians report that a staff member could do the job of the EHR system, and 43% say that their EHR system slows them down. Despite these findings, only 18% of physicians prefer paper records and 61% say that EHRs improve quality of care.

Physicians surveyed cited a disconnect between the EHR system’s capabilities and the actual needs of doctors and practices. Nearly 20% of eligible professionals, mostly physicians, have dropped out of the meaningful use program, according to the AMA.

“Both primary care and subspecialist physicians noted a mismatch between meaningful-use criteria and what they considered to be the most important elements of patient care,” the survey’s authors said. “Some physicians who did not provide primary care reported that meaningful-use criteria seemed to be more appropriate to primary care practice. However, primary care physicians also reported that the documentation burden of satisfying meaningful-use criteria detracted from patient care.”

The AMA has advocated revising meaningful use by replacing “all-or-nothing” polices and allowing for more flexibility for practices and vendors to meet attestation. “Allowing physicians who are having difficulty updating software to use electronic health records that have been certified for the 2011 edition for 2014 and giving them an additional year to achieve Stage 2, could help more physicians meet the program requirements and avoid a financial penalty in 2015,” says Steven J. Stack, MD, AMA president-elect and immediate past chairman of its Board of Trustees. “Although those proposed changes are helpful, we believe the current requirements, particularly for Stage 2, still remain a long shot for many doctors to meet.”

EHRs require many physicians to perform “more mundane clerk-like duties,” according to one primary care physician interviewed for the study. The survey found that 43% of physicians believe that EHRs slow them down. “Physicians who did not use scribes reported that their EHRs required them to perform tasks below their level of training, decreasing their efficiency,” the study’s authors said.

One primary care physician responded that the EHR system is not a “one-time investment,” and was worried that too many options on the market would lead to a bad decision, and a loss of money.

“Some physicians, especially those who owned or who were partners in their practices, reported that investing in EHRs exposed their practices to significant financial risks. In particular, the costs of switching EHRs-which could become necessary due to factors beyond a practice’s control-were of high concern,” said the survey’s authors.

In spite of EHR dissatisfaction, most physicians have faith that the future of EHRs will offer more interoperability and intuitive intelligence. “I know that 10 years from now or 15 or 20 years from now, I can imagine that the next level of EHR is going to be software, smart software that can scan an eight-page document and then give me a third of a page summary of important information, because there was some software engineer who’s medically trained. That, to me, makes the next logical step,” one physician surveyed said.