Doctors' 5 Biggest Gripes About EHRs

Keith L. Martin

Disclosures

August 26, 2019

Although several studies, such as the one in Health Affairs, have tied burnout to EHR use, opinions vary on the true connection.

Charles Alessi, the chief clinical officer for the Healthcare Information and Management Systems Society, thinks it is not necessarily the fault of the EHR. He believes physician dissatisfaction is the result of various factors, from being asked to do more with fewer resources to the changing nature of the patient-doctor relationship.

"How do you adequately describe the fact that the consultation between the person and the physician has changed, where the physician's role is now more someone who accompanies [a patient] through a life course versus a didactic giving of information? That's quite a difficult concept to describe," he says. "It's far easier to say, 'it's all the EHR.'"

CMS continues to roll out its Patients Over Paperwork initiative to decrease clinician burden, but one area has received too little attention to date—that of administrative burden, according to Peter Basch, MD, an internist in Washington, DC, and senior director for IT quality and safety and national health IT policy for MedStar Health.

"EHRs could serve as the infrastructure to dramatically reduce paperwork or administrative burdens, and with the newly gained time with each patient encounter, clinicians could redirect their focus to improving quality and safety," he says. "It was, at least in theory, a win-win. Unfortunately, that never happened. In addition to adding documentation and regulatory burden, administrative burden was ignored."

3. EHRs Are Not Intuitive or User-Friendly

When it comes to making improvements to EHR systems, the majority of physician respondents simply want a more intuitive and doctor-friendly technology solution, according to the Medscape poll.

Turpen, the emergency medicine physician in New Mexico, sees these problems on a daily basis as he and other members of his care team lose precious time processing patients through their systems and working with incomplete information.

What other industry in America would tolerate buying an expensive software system that makes it less efficient and less confident while putting less money in its bank?

"What other industry in America would tolerate buying an expensive software system that makes it less efficient and less confident while putting less money in its bank? Who would ever tolerate this?"

According to experts, one key to improving EHRs—the ones currently being used and those in the future—is personalization.

Taylor Davis, vice president of innovation at the health IT data and insights firm KLAS Research, compares personalizing EHRs with using the apps on your smartphone. Users download, click, drag, and drop to where the parts of the app make sense. With EHRs, personalization is possible, for the most part, but doctors either don't do it or don't know how.

"By our estimates, less than 50% have personalized their EHRs," says Davis. "So they [use] the software every day and think about how stupidly it is laid out. But most software has options to move some things around. It's like walking into your living room every day and bumping into the couch. You say, 'Who's the idiot who put this here?' It was you—you are responsible for the layout."

4. EHR Data Are Redundant or Hard to Find

Nearly 30 years ago, Kenneth J. Hoffman, MD, MPH, helped develop a prototype EHR for the US Army's alcohol and drug treatment program. To create a system that worked for physicians, Hoffman and others got frontline clinicians involved in the process to create treatment optimization while also eliminating redundant data collection.

According to Hoffman, with screen designs and screen flows to improve the patient-provider encounter, all the data were mapped using the same terminology so all users were on the same page when it came to direct patient care, required reports, and analyzing outcomes.

Today, Hoffman, a psychiatrist and retired colonel, says the problem is that the EHRs currently in use today require frontline physicians to electronically input large amounts of redundant data while also trying to interact in a meaningful way with their patients. Critical information gets buried in too many pages of data, and it becomes difficult to focus on the main issues or questions that should be the purpose of the patient visit.

The most relevant information and latest information needed for a current encounter can be easily obscured and difficult to discover. Hoffman feels that it should be easier, but it isn't.

"If anyone designed the dashboard of a car like they've designed [EHRs], there would be no speedometer," he says. "You'd have reams of printouts of the history of your speed while the police and insurance would get the alerts of a problem first. You'd be the last to know."

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