Electronic health records (EHRs) were supposed to improve the quality of care, make healthcare safer and more efficient, and save clinicians time. Over the last few decades, we’ve spent billions of dollars in hopes that EHRs could revolutionize healthcare in the same way automation has advanced banking, commerce and other industries.
Despite tremendous strides, EHRs have not fully delivered the transformative benefits that many stakeholders had optimistically anticipated. In fact, EHRs are often blamed for decreasing clinician productivity, compromising patient safety and interfering with the physician/patient relationship.
We can debate the relative costs and benefits of EHRs, but one thing that’s clear to me is this: Physicians are EHRs’ biggest victims.
Consider the near-epidemic levels of physician burnout. In a recent Medscape survey, 44% of physicians admitted to burnout. Survey participants said that one of their leading stressors is EHRs, which are rarely optimized to support clinician workflows.
Physicians’ ongoing frustrations with EHRs are well-documented, and in recent years numerous industry organizations have called for changes to make EHRs more physician friendly. For example, in 2014 the American Medical Association (AMA) published a brief that outlined recommended priorities for improving EHR usability. The brief included eight key challenges that physicians faced with EHRs, including the lack of interoperability impacting care coordination, interference with the patient visit, limited flexibility for customizing based on individual physician practice patterns, and insufficient support for incorporating end-user feedback into product design and enhancements.
The AMA urged health information technology leaders to make usability a national priority and proposed eight solutions to facilitate the physician’s ability to provide high-quality care. Based on input from practicing physicians, health informaticists, CIOs and other industry leaders, the AMA outlined possible solutions that would minimize EHR inefficiencies and allow physicians to remain focused on the delivery of quality care.
Fast forward five years and look where we are today. Burnout rates continue to escalate—and physicians are still the victims of inefficient EHRs.
In a recent perspective essay published in the Journal of the American Medical Informatics Association, AMA researchers again addressed the EHR usability issue, noting that physicians now spend more time completing administrative tasks in their EHRs than engaging in direct face time with patients. The authors pointed to the “increasing rates of burnout associated with EHR use” and again called for improvements in how EHRs are developed and used.
Physicians can remain EHRs’ biggest victims for another five or 10 years, or we could take action and finally make EHR usability a national priority. I’d urge vendors, healthcare organizations, payers, lawmakers and regulatory bodies to give serious consideration to changes that would enhance EHR usability and positively impact professional satisfaction and patient care.
The AMA’s most recent recommendations include:
- Decreasing burdensome documentation requirements for payment and quality reporting. Payers and regulators must remember that clinicians’ first job is patient care.
- Actively engage physicians in the EHR implementation process. Organizational leaders should consider physician workflow requirements and support system designs that enhance care coordination.
- Complete pre- and post-implementation testing using rigorous, real-world scenarios focused on improving safety and reducing clinician burden.
- For health IT vendors, increase transparency around product costs, functionality, and performance. In addition, vendors should support advances in voice recognition, artificial intelligence, and other technologies with a focus on user-centered design to catalyze improvements in EHR usability and interoperability and reduce cognitive workload.
To supplement the AMA’s recommendations, I would also suggest:
- More flexible EHR workflows that support the individual thought processes of each physician
- Better access to critical data at the point of care
- The elimination of data-blocking on the part of vendors and healthcare organizations. This would boost interoperability efforts, optimize clinical decision-making and enhance patient safety.
- The promotion and adoption of app-based solutions that address usability issues without the need to rip and replace current EHR systems.
We can no longer ignore the needs of physicians as we work to digitize healthcare. We must start looking at EHRs as a tool and not a task. EHRs hold tremendous potential to transform healthcare, but we won’t realize their full benefit until we make EHRs more usable for physicians.