A Love/Hate Relationship: Dealing with EHRs

Whether you view electronic health records as a lifesaver or a necessary evil, they are here to stay. While none have been deemed perfect, feedback shows they are gaining acceptance, begrudgingly or not.

The vast majority of U.S. providers and hospitals have completed the arduous task of converting their health records to digital. According to a Medscape survey of about 18,500 U.S. physicians, 83% are using electronic health records (EHR). The transition was often messy in the beginning, but how does the medical community feel about electronic systems now that they are the norm?

The answer to this question can be quite varied depending on the system a physician uses. The EHR market continues to be widely fragmented, with a whopping 22% of physicians using a system that has less than 1% of the market share. Epic holds the greatest market share at 23%, and the remaining 55% of physicians use one of 17 systems that hold market shares ranging from 1% to 9%.

While each of the many EHR programs has perks and quirks, a few consistent areas of feedback from physicians have emerged.

Practice Operations

Despite the tedious aspects of data entry, 63% of physicians surveyed think that the EHR has improved documentation at their practice. The ability to build detailed, searchable records has proven useful in making more precise decisions about patient care. Such documentation is especially important for diseases like diabetes that require constant monitoring and individualized treatment plans.

EHR systems can track data about a patient’s A1C levels, for example, and help identify relevant trends. This functionality proves enormously useful for a multitude of conditions ranging from asthma to obesity.

In addition to charting health indicators, better documentation allows for a more streamlined coding process. The increased efficiency bolsters revenue by saving time and ensuring that the necessary codes are all reported. Structured templates may further improve coding and billing.

The surveyed physicians were divided over the effect of EHRs on patient service, however. Although 32% felt that the digital system improved patient service, 38% thought that their EHR worsened service. A similar discrepancy applies to the clinical side, with 34% of physicians saying it betters clinical operations and 35% saying it worsens them.

Some physicians commented on specific aspects of EHR systems related to operations. “E-prescribing is awesome,” wrote one individual. Others claimed that electronic records are “more organized” and legible, and liked that the systems are “accessible from home after hours” and that they save all data in one place.

Doctor-Patient Relationships

In a major change from previous surveys, physicians felt overwhelmingly negative about the effects of EHR systems on patient encounters. Seventy percent claimed that electronic records decreased face-to-face time with patients. Although EHRs can increase efficiency in other areas, 57% of participating physicians also said that their digital system decreased their ability to see more patients.

These negative changes are due to increased documentation time, which cuts into both appointments with patients and any available work time outside of appointments.

A decade ago, a team of researchers predicted that documentation time would continue to be a major issue with electronic records. They published a review of 23 time-efficiency papers in the Journal of the American Medical Informatics Association and found that bedside and point-of-care systems added 17.5% documentation time, while the use of central station desktops increased work time from 98.1% to 328.6% per physician shift.

“A goal of decreased documentation time in an EHR project is not likely to be realized,” the authors stated.

A 2014 study from Northwestern University gave more insight into how EHRs reduce patient interaction. The research showed that physicians using paper charts spent only 9% of the appointment time looking at the chart, while those using electronic records spent one-third of the visit looking at a computer screen. The study recommends making patients part of the EHR documentation process to increase interaction, rather than hiding the screen from them.

Finding a happy medium between accurate, thorough documentation and face-to-face time with patients remains one of the biggest EHR-related challenges. On the bright side, the survey showed that 35% of physicians feel they are better able to respond to patient issues and 33% think they more effectively manage patient treatment plans thanks to electronic records — compared to 27% and 26% who felt the opposite, respectively.

Down the EHR Road

Once physicians get used to an EHR, they seem to like it a lot more. With many late adopters finally going digital due to meaningful use deadlines, much of the negative feedback in the survey could be tied to frustrations of learning a new system. Over time, 81% of physicians surveyed said that they felt more comfortable with their EHR while 78% had already attested for stages one or two of meaningful use.

Additionally, 42% are somewhat or very satisfied with their EHR vendor, 17% are neutral, and 9% do not interact with their vendor — leaving a minority of 32% of providers who are unhappy with their vendor. Nonetheless, only 16% intend to change vendors for any reason.

Despite significant qualms with documentation inefficiencies, patient interaction, and the privacy concerns that come with any digital system, EHRs continue to increase in popularity. Physicians are certainly not 100% happy with the EHRs available to them, but seem to have accepted the loss of paper records. With any luck, the ongoing competition for market share among vendors will motivate improvements and upgrades.

Mapes is a Washington D.C.-based freelance writer and a regular contributor to Endocrine News. She wrote about the human epigenome in the August issue.