EHR User Satisfaction Declines in Meaningful-Use Era

March 06, 2013

As more and more physicians adopt electronic health record (EHR) systems, they like them less and less, according to a new survey from the American College of Physicians (ACP) and a group that it cofounded to promote the technology.

A likely reason for the greater discontent, say experts, is that software vendors have made EHR programs more click-intensive by adding features to help physicians meet federal "meaningful use" requirements and earn a bonus.

The ACP and AmericanEHR Partners described the downhill trend for user satisfaction in a presentation yesterday at the annual conference of the Health Information and Management Systems Society (HIMSS) in New Orleans, Louisiana.

The ACP and AmericanEHR Partners have surveyed clinicians about EHR systems since 2010. In their latest survey, they found that the percentage of EHR users who are very dissatisfied with the technology rose from 11% in 2010 to 21% in 2012. Meanwhile, the percentage saying they were satisfied fell from 39% to 27%. The ranks of the very satisfied decreased by an insignificant amount, according to the 2 groups.

Other survey findings suggest clinicians are banging computer screens in frustration:

  • The percentage of clinicians complaining about EHRs being hard to use rose from 23% to 37%.

  • The percentage of users who had not returned to their pre-EHR levels of productivity rose from 20% to 32%.

  • The percentage of users who were very dissatisfied with the ability of their system to improve care increased 10%, and the percentage of those who were very satisfied in this regard decreased by 6%.

  • Thirty-nine percent of users said they would not recommend their EHR to a colleague, up from 24% in 2010.

Sources of Discontent

The dip in EHR user satisfaction coincides with the federal meaningful-use program, which began awarding bonuses to physicians in 2011. To qualify for the money, physicians have to use an EHR system certified as capable of transmitting prescriptions electronically, generating drug interaction alerts, capturing a patient's smoking status, and performing other chores considered part and parcel of meaningful use.

EHR vendors revamped their programs to give physicians these new tools, which have added more mouse clicks to their workload. Making matters worse, meaningful-use functions in some programs are poorly designed, said Jason Mitchell, MD, director of the Center for Health Information Technology at the American Academy of Family Physicians (AAFP), a member of AmericanEHR Partners.

"They could have done a better job, and they'll have to do a better job, or we'll see a continued decline in user satisfaction," Dr. Mitchell told Medscape Medical News.

Discontent with EHRs also could stem in part from inadequate training, said Alan Brookstone, MD, who helped present the survey material yesterday at HIMSS. In some medical practices, a week's worth of needed instruction gets boiled down to a few days, Dr. Brookstone told Medscape Medical News.

Software vendors stretched thin by more customers than they can handle do not make matters any better. Dr. Brookstone, whose company Cientis Technologies cofounded AmericanEHR Partners, cited a small medical practice in his HIMSS presentation that repeatedly asked its EHR vendor for in-house training. "We...can't get anyone to come out," said one of its physicians.

To the AAFP's Dr. Mitchell, the drop in user satisfaction may partly reflect the surge of physicians who adopted EHRs in response to the federal meaningful-use program. Unlike early adopters, they may have rushed into the world of digital charts more preoccupied with bonus money than with how the technology could revolutionize patient care. "Perhaps they didn't do as much of their homework," said Dr. Mitchell. In so many words, they were primed for frustration and disappointment.

However, Dr. Brookstone said in his HIMSS presentation that higher dissatisfaction is more related to veteran EHR users who have soured on the systems during the meaningful-use era, "and is not easily explained away by newer users alone."

The survey results come on the heels of other studies that have punctured the optimism about EHRs. A study on EHR information overload published online March 4 in JAMA Internal Medicine showed that primary care physicians in Veteran Affairs hospitals were so bombarded by onscreen alerts and notifications that they frequently overlooked incoming test results. That same day, Health Affairs published an article projecting a negative return on investment over the course of 5 years for most practices in a large EHR pilot project in Massachusetts.

These growing pains of digital medicine will not cause physicians to revert to paper charts, said Dr. Mitchell, noting that more than 70% of family physicians already have switched to EHRs.

"We're past the tipping point," he said. "We're past the point of no return."