Top Challenges Number 4: EHRs that don’t work well enough

It has never been such a challenging time to be a physician. Every physician, whether they own their own practice or are employed by a hospital or larger health system, must navigate a host of obstacles each and every day: Payment hassles, staffing issues, patient communication obstacles, technology burdens, long hours and burnout, and much more. 

Each December, Medical Economics presents its list of the top challenges facing physicians going into the next year. This year we focused not only on the challenges, but also practical tips physicians can start using right away to make practicing easier.

Challenge 4: EHR usability and interoperability

EHRs remain a serious challenge for physicians, and that shows no signs of changing in 2020.

The problems of clunky EHR interfaces and lack of seamless communication between systems are deep-rooted and complex. The end result is products that are expensive and, as a growing body of research indicates, contribute to physician burnout and worse health outcomes for patients.

“I'm not surprised at all the physicians find the EHR is not complementary to the care of their patients, and have difficulty in their use.” says Andrew Pecora, MD, CEO of Outcomes Matter Innovations, and Chairman and Founder of COTA Healthcare.

Pecora spoke recently with Medical Economics about the problems with EHRs.

Medical Economics: EHRs were supposed to transform healthcare. But many doctors would say they've caused more problems than they fixed. What went wrong?

Pecora: EHRs were built to be billing systems. They were built to look at the content of a note, not to care for patients. And that really hasn't changed. That's not an absolute statement, because there are now changes being made. But they're not user friendly. They're not intuitive. They don't complement the way the doctor thinks or approaches seeing a patient, examining a patient, and making a clinical decision to how best to treat the patient. So really, it's just another thing to do, whereas they used to just write a note.

Medical Economics: How would you assess the state of EHRs today?

Pecora: I think EHR vendors in general understand there needs to be an EHR 2.0, that the versions that were built to support billing and coding are a necessary platform but nowhere near sufficient. And when you look at the content and information technology now, we're talking about machine learning and artificial intelligence, there needs to be add-ons that make the note much more intuitive to the doctor, particularly when it's doctors in a specialty with decision support with real time analytics to help you make a decision best for the patients. Also, there's way more we can do to make the note writing itself easier for the doctors. We pay physicians to make a good decision for their patient. And that has to be the emphasis. Physicians feel like they've become glorified note-keepers, and the value of the service they provide has been diminished.

Medical Economics: When physicians say they want usable systems, what actually are they looking for? What capabilities do they need to succeed?

Pecora: Well, the biggest enemy to a doctor is time. Patients and physicians are both complaining that not enough time is spent face-to-face, hands on the patient, sitting there talking to the patient about not just their illness of the moment, but how their life is going. That empathy is so important to being a doctor. Instead all of that time is sitting by the computer, making sure you get your 10 elements of this note and 15 elements of that note. That should be automated. There is no good purpose for a doctor wasting their time typing or dictating stuff that should just be automated, and a doctor shouldn't be penalized for that.

Medical Economics: Physicians regularly point to EHRs as a contributor to physician burnout and career dissatisfaction. How did we get here?

Pecora: Fundamentally, physicians went into the practice of medicine to care for their patients, not to write notes. Right now the emphasis is on writing the note and less on caring for the patient. It is because the number of patients per hour a doctor needs to see given what has happened to reimbursement has gone up. And the amount of documentation necessary to have the coding for a proper bill has gone up. So when you look at those two things, what has been sacrificed? What has been sacrificed is the very reason doctors went into medicine: the time they get to spend in a caring environment with their patients. That's been taken away.