EHRs in the Practice: Are Things Getting Better?
In Medscape's prior EHR Report, physicians complained that their EHRs created numerous problems in the office, particularly in doctor-patient interaction. So this year, in addition to asking survey participants to rate their EHRs by various criteria, we also asked them whether their experiences with EHRs are improving.
When it comes to the doctor-patient relationship, however, it's far from getting better; EHRs are viewed as being increasingly problematic by participating physicians.
In our 2012 survey, nearly a third of the participants said the EHR had a negative impact on patient care. This year, some responses were significantly more negative. For example, 70% of respondents said the EHR decreases their face-to-face time with patients, and 57% said it decreases their ability to see patients.
Be that as it may, about a third (35%) of participating doctors said the EHR improves their ability to respond to patient issues, and 33% said it allows them to more effectively manage patient treatment plans.
Another improvement: 81% of respondents in our 2014 report agree that their EHRs have become easier and more comfortable to use over time; only 19% disagree. Practice may not make perfect, but it appears to enhance the user experience.
However, an EHR's ability to help with staff management -- such as assigning them tasks, moving messages around the office, and documenting the completion of patient service items -- leaves much to be desired. Just over half of our respondents (53%) feel that their EHRs do not help with these issues.
"The reason is that some EHRs do not have workflow tools to meet all of these requirements," Ronald Sterling explains. Office workflow and staff management capabilities, he adds, are not requirements for certified EHRs.
Privacy Concerns Have Grown Tremendously
Privacy concerns, which were barely on the radar screen in our 2012 EHR Report (77% of participating doctors back then said they had no privacy concerns), are now top of mind among the physicians we surveyed this year. In our 2014 report, only 17% of respondents said they had no concerns about privacy.
"I think this greater awareness is from hospital training," says Sterling, "as well as physicians who had to return their EHR incentive money because they did an inadequate security risk assessment."
"The real risk for small practices is that they do not have appropriate policies and procedures, and fail to train their staffs in HIPAA privacy and security requirements," he adds.
Meaningful Use Participation
As for meaningful use participation, 78% of respondents said they were attesting to meaningful use Stage 1 or Stage 2 in 2014. But the number of physicians who say they will not attest is growing. In 2012, 14% of survey respondents said they wouldn't bother to attest. In 2014, 16% said they will never attest to meaningful use requirements, and another 6% of participants said they are abandoning meaningful use after meeting the requirements in previous years.
Thus, 22% of physicians surveyed this year are opting out of or disregarding the meaningful use program.
Still, it's clear that while many physicians feel their EHRs are impairing the doctor-patient relationship, others are getting more used to their EHRs and can often see some benefits. Many respondents listed ways that the EHR affects practice operations. A representative sample includes: "E-prescribing is awesome"; "More organized"; "Legibility"; "Accessible from home after hours"; and "Saves all my data in one place." The impact of EHRs will continue to grow.