EHR Use a Bitter Pill for Many Physicians: Study Reveals Physicians’ Perceptions of EHR Systems and Points to Remedies

EHR Use a Bitter Pill for Many Physicians: Study Reveals Physicians’ Perceptions of EHR Systems and Points to Remedies

By Michael Solomon, PhD and guest blogger Stephen Meigs, DHA

Almost six years after the launch of the Medicare and Medicaid electronic health records (EHRs) incentive program, EHRs are in place in the vast majority of physician practices. Physicians have invested in EHRs with the expectation that the technology will improve the quality of care and make their practices more efficient. For many, realization of these benefits remains elusive. Our study of small physician practices, recently published in Perspectives in Health Information Management, sheds new light on why – and reinforces results from surveys of physicians showing that EHR systems negatively impact productivity and lengthen their workdays.

Using rigorous case study protocols, we interviewed physicians practicing in small group settings. This research brings a new perspective to the topic of physician EHR satisfaction by exploring in-depth the perceptions of physicians at three levels of adoption: (1) doctors who have adopted EHRs throughout the patient care process, (2) those who have only partially adopted EHRs and, (3) doctors who have not implemented EHR systems at all. Six themes emerged from these case studies. Here we will highlight three that have major implications to the future role of EHR systems in the health care industry’s shift to outcomes-based payments.

First, most adopters and partial-adopters reported that using EHRs to document patient care during the actual encounter is a struggle, forcing them to implement paper-based workarounds. Not only does this practice create inefficiencies, but data errors could also be introduced, adversely affecting patient care. When physicians report longer workdays, the EHR clinical documentation process is the likely culprit.

Second, the majority of physicians we interviewed expressed frustration with the inability of their EHR systems to exchange data with other systems. Especially striking was that many physicians across all adoption levels were skeptical about interoperability ever arriving to help them better care for their patients.

Last and perhaps the most strategically important finding was that more than three-quarters of adopters and partial-adopters do not believe that using EHRs improve the quality of care that they deliver to patients. Some participants believe EHR use may instead negatively affect the quality of care, describing consultation reports generated from EHR systems that contained erroneous and extraneous data.

 This study brings clarity to the most significant issues with the use of EHRs – particularly among small physician groups – and suggests what should be the most important strategic imperatives for EHR system improvement. As the Centers for Medicare and Medicaid resets its focus beyond meaningful use to EHRs as a technology enabling providers to move the needle on quality measures, two priorities stand out because of their direct impact at the point of care on quality and physician productivity: (1) making electronic clinical documentation more usable by clinicians during the patient encounter, and (2) providing seamless access to EHR data among all of a patient’s care providers. As long as EHR systems fall short on these two critical capabilities, expect strong headwinds in efforts to improve physicians’ perceptions of the value of this technology to their practice.

Please share your impressions of our findings and the broader challenges of optimizing the use of EHRs in patient care.  

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