What's ruining medicine for physicians: Difficulty using EHRs

At the end of every year, Medical Economics publishes a list of the top challenges facing physicians. This list is generated by surveying our physician readers.

For this year’s list, we decided to recast the question. Instead of asking what challenges physicians face, our editorial staff wanted to hone in on what issues annoy and frustrate doctors and get in the way of what’s truly important: Treating patients and running practices.

And so we asked physicians in a poll: “What ruining medicine for physicians?”

In our list of the nine issues ruining medicine for physicians, the goal is not to dwell on the negative aspects of working as a physician. Instead, we wanted to show our readers that they share common challenges when dealing with the vexing issues facing primary care in today’s complex healthcare environment. Each piece also offers practical solutions that physicians can start using in their practices today.

#2 Difficulty using EHRs

Physicians largely dislike their EHR systems and feel  they are stuck with the ones they have, even when they are unhappy with it.

The Medical Economics EHR Report, published in October, found that 70 percent of physicians would like to switch systems but don’t because of high costs and lack of better options. In addition, about 57 percent would not recommend their current system to a fellow physician.

These problems are leading many physicians to simply quit. The Doctors Company, a medical malpractice insurer, released a report earlier this year which found that 54 percent of physicians plan to retire within the next five year because of burnout, with EHRs being a major contributor.

The report also revealed that 61 percent of doctors believe EHRs have a negative impact on efficiency and productivity and 54 percent feel they  negatively affect the physician-patient relationship.

Richard E. Anderson, MD, FACP, chairman and chief executive officer of The Doctors Company, says there are two problems with EHRs. First, they require hours of duplicative and often unnecessary data input. Second, the systems are non-intuitive, vary widely, and don’t communicate with one another.

“The experience in medicine has been that EHRs actually reduce physician productivity, and often impede rather than facilitate the care of patients,” he says. “This is the exact opposite of what we seek when we deploy a new technology.”

Christopher Maiona, MD, chief medical officer of PatientKeeper Inc., which provides financial applications to streamline physician workflow, says that based on 20 years of conversations as a hospitalist, EHRs generally confound and frustrate physicians. 

“Problems include counterintuitive workflows, poor interfaces, bloated clinical documentation, and too many unhelpful alerts,” he says in an e-mail. “It is sad but true that healthcare is the only industry which, in the course of computerizing its operations, has made its most valuable, highly compensated workers-physicians-less productive by increasing their administrative burden.”

Thoughts from users

John Nguyen, MD, chief medical officer at QueensCare Health Centers in Los Angeles, says for EHR use to become easier, providers should welcome feedback and be open to learning. 

“An organization should be well-equipped with EHR specialists or equivalent positions to provide training as needed to all staff and providers,” he says. 

Maiona says every hospital and medical practice’s goal should be to make EHRs a clinically indispensable tool for physicians to deliver optimal patient care. And that begins with improving EHR usability. 

“In the mind of a physician, EHR usability refers to accessing and acting on patient information with ease. It’s having data presented in a manner that is consistent with the physician’s unique thought process and workflow, and that allows them to intuitively act on that information on the fly,” he says. “It also means doing no harm.”

Since hospitals have made huge investments in their EHR systems, Anderson says, they need to find ways to get the most out of those investments.

He says technology such as workflow applications, mobile device access, voice enabling tools and secure messaging apps assist in making things easier for physicians and therefore help in their use of EHRs.

Richard Schuster, DO, a family practitioner at Schuster Family Medicine in Indianapolis, Ind., says the problem with most EHRs is that they are not built to be health or medical records and are essentially billing platforms designed to extract data points. 

“They are not designed to communicate or record effectively health or disease information,” he says. “They do not tell the patient story, which is what the notes should communicate. They are difficult to use and time consuming to learn and manage.”

Schuster believes the Affordable Care Act could have served to begin a  conversation to identify the problems in EHR systems and seek solutions over time, but it wasn’t. 

“We need to sit down as a country, identify what our priorities and values are, and begin designing the system around those things,” he says.