More trouble for EHRs?

Have taxpayers or physicians been getting their money’s worth from electronic health records (EHRs)? Two recent studies suggest that the answer is ‘no.’

Taxpayers’ role in encouraging EHR adoption has come in the form of government subsidies made available to medical practices through the Meaningful Use (MU) program. A study published recently on the website of the Journal of the American Medical Informatics Association looks at the impact of those subsidies, which by the end of 2014 had totaled more than $28 billion.

The authors used several mathematical models to extrapolate EHR adoption rates from the years before passage of the 2009 Health Information Technology for Economic and Clinical Health (HITECH) Act-which appropriated funds for MU payments-through 2017. Then they compared those rates with actual adoption rates to-date. They found that “passage of the HITECH ACT and the subsequent subsidy payments contributed statistically insignificant nudges to the EHR diffusion curve of less than one percentage point and a half percentage point, respectively. “

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They add that a National Bureau of Economics Research study of hospital EHR adoption predicted that hospitals would have achieved a 77% adoption rate in 2013 without MU subsidies-two years later than they did with the subsidies.

But even while more doctors are using EHRs, they are growing increasingly unhappy with the technology, as revealed in a recently-published survey of physicians, nurse practitioners and physician assistants. The survey, a joint effort of the American Medical Association and AmericanEHR Partners, found that just 34% of the 940 respondents were “satisfied” or “very satisfied” with their EHR system in 2014, compared with 61% in 2010.

Satisfaction with specific EHR products showed similar declines. In 2014 31% of respondents said they would purchase their EHR system again, compared with 42% in 2010, and 33% said they would recommend their system to a colleague, versus 47% in 2010.

When asked about their EHR’s impact on a variety of specific services and functions:

• 55% said improving practice efficiency was difficult or very difficult using their EHR

• 72% said decreasing their workload was difficult or very difficult

• 46% said it was difficult or very difficult to create templates for specific clinical conditions

Not all the report’s findings are negative. For example, two-thirds of respondents said it was easy or very easy to access their EHR remotely, and 38% said it was easy or very easy to use their EHR’s evaluation and management coding support when charting a patient visit (compared with 28% who said it was difficult or very difficult, and 22% who said it was neither easy nor difficult.)

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In terms of overall practice impact, the most positive aspect respondents reported (42%) was on staff time spent processing prescription and refill requests, and the most negative (35%) was that it required hiring additional employees/staff members.

The authors note, however, that satisfaction with EHRs increases with time, with only 22% of practices using a system for a year or less saying they are satisfied or very satisfied with it, compared with 50% who have been using theirs for five years or more. And because EHR adoption rates among office-based physicians increased significantly from 2012 to 2013 (71.8% to 78.4%), the influx of new users “may have had a negative influence on both satisfaction with and impact on practice,” the authors say.