News Feature | December 6, 2013

EHRs Affecting Physician Professional Satisfaction

Source: Health IT Outcomes
Katie Wike

By Katie Wike, contributing writer

HTO Stres (Word)

The benefits EHRs are clear, but physicians say they are hampering quality personal care and leaving providers dissatisfied

A press release issued in support of a RAND Corporation study notes, “Being able to provide high-quality healthcare is a primary driver of job satisfaction among physicians, and obstacles to quality patient care are a source of stress for doctors. While physicians note some advantages of electronic health records, physicians complain that the systems in use today are cumbersome to operate and are an important contributor to their dissatisfaction. The findings suggest that the factors contributing to physician dissatisfaction could serve as early warnings of deeper quality problems developing in the healthcare system.”

The RAND study found, “Electronic health records have affected physician professional satisfaction. Those surveyed expressed concern that current electronic health record technology interferes with face-to-face discussions with patients, requires physicians to spend too much time performing clerical work, and degrades the accuracy of medical records by encouraging template-generated notes.

“In addition, doctors worry that the technology has been more costly than expected and different types of electronic health records are unable to ‘talk’ to each other, preventing the transmission of patient medical information when it is needed.”

“Physicians believe in the benefits of electronic health records, and most do not want to go back to paper charts,” said Dr. Mark Friedberg, the study's lead author and a natural scientist at RAND. “But at the same time, they report that electronic systems are deeply problematic in several ways. Physicians are frustrated by systems that force them to do clerical work or distract them from paying close attention to their patients.”

RAND said the findings suggest factors contributing to physician dissatisfaction could serve as early warning signs of deeper quality problems developing in the healthcare system. EHR systems have been touted as a great addition to the field and a revolution in records keeping, but they are also burdening physicians and taking away the personal aspect of care. In fact, six in ten physicians are dissatisfied with the way EHRs affect their offices’ work flow.

Doctors are spending more time inputting information into EHRs, and some providers are keeping long hours to finish the added work. Some say doctors hate EHRs in part because they’re spending only 28 percent of their time seeing patients now.

The RAND study also found:

  • Physicians in multiple specialties and practice models noted their EHRs improved their abilities to access patient data, both in healthcare settings and at home.
  • Physicians and administrators in some practices described how EHRs improved their ability to provide guideline-based care and track patients’ markers of disease control over time. These advantages were predominantly noted in primary care practices.
  • Interviewees described enhanced communication through the medical record itself (e.g., by facilitating access to other providers’ notes and eliminating illegible handwriting) and through EHR-based messaging applications (e.g., patient portals). Improvements in between-provider communication were most commonly noted in larger practices, where all providers were on the same EHR.
  • The majority of physicians who interacted with EHRs directly (i.e., without using a scribe or other assistant) described cumbersome, time-consuming data entry. For many physicians, voice recognition programs were not accurate enough to improve on typing. Although more senior physicians, who tended to describe their typing skills as relatively weak, articulated these concerns most clearly, data entry was difficult for many younger physicians as well.
  • Some physicians, especially those who owned or who were partners in their practices, reported that investing in EHRs exposed their practices to significant financial risks. In particular, the costs of switching EHRs—which could become necessary due to factors beyond a practice’s control—were of high concern.
  • Almost universally within our study sample, physicians reported support for EHRs in concept. Some physicians hoped that future developments in artificial intelligence and health information exchange would solve problems with current EHRs.

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