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Readers Write: Physicians: The Ultimate Victims of Unusable EHRs

September 4, 2019 Readers Write 3 Comments

Physicians: The Ultimate Victims of Unusable EHRs
By David Lareau

David Lareau is CEO of Medicomp Systems of Chantilly, VA.


It’s been a decade and a half since President George W. Bush announced his vision for making EHRs accessible for all Americans by 2014. Since President Bush first shared his plan, overall EHR adoption has skyrocketed. As of 2017, 86% of office-based physicians and 96% of all non-federal acute care hospitals had adopted some sort of EHR system, according to the ONC.

But what has this digital transformation really cost us?

I’m not referring to the billions of dollars that the government has paid providers for their meaningful use of EHR technology. The costs that concern me are the ones incurred by the frontline users of EHRs: the clinicians who have been forced to use inefficient systems that cripple their productivity and are fueling unprecedented levels of physician burnout.

In our rush to digitize medical records, we have failed to design and deploy solutions that work for physicians and enhance clinical decision-making. Instead of creating systems that deliver efficient clinical workflows, EHR vendors have been forced to prioritize R&D projects to satisfy regulatory and reporting requirements. Meanwhile, the regulations mandated by the government and payers have largely failed to include standards that enhance EHR usability.

By failing to adequately address usability, physicians have become the ultimate EHR victims.

EHR usability is a major source of frustration and stress that is contributing to physician burnout. According to a recent Medscape survey, 44% of physicians admit feeling burned out and point to EHR use as one of their leading stressors.

Despite their great promise, EHRs are a source of continued physician frustration because usability has remained an afterthought for developers and regulators. The lack of EHR usability hurts physicians, nurses, and even patients.

We could wait for the government to mandate additional usability standards. Alternatively, health IT stakeholders could commit to making EHR usability a top priority and begin taking immediate steps toward much-needed changes.

A few key areas that could make a big impact on EHR usability include:

  • Support for flexible EHR workflows. Physicians have varying workflow needs, especially across specialties. Rather than forcing clinicians to adapt their workflows to satisfy the requirements of an EHR, EHR vendors must support flexible designs that allow users to filter information in ways that support the individual thought processes of each physician.
  • Better point-of-care information. By making it easier for users to access the specific information they need, when they need it, for the patient in front of them, clinicians can drive better outcomes and increase their productivity.
  • Promoting interoperability. Physicians need access to a patient’s complete medical record to optimize clinical decision-making and ensure patient safety. However, many providers and EHR vendors resist opening systems to share patient data out of fear of losing market share. By putting an end to data-blocking, physicians will feel more confident that they are equipped to deliver the highest quality patient care.
  • Involving physicians. Both EHR vendors and health system leaders have largely failed to incorporate input from clinicians. If we want physicians to embrace EHRs, rather than viewing them as an additional burden, we must involve clinicians in the design process and seek their guidance to modify workflows to enhance patient care and increase productivity.
  • Adopting app-based solutions. Healthcare providers have spent millions over the last decade implementing new EHRs. Few organizations can afford the financial and manpower disruption of starting a new EHR implement from scratch, regardless of how inefficient their legacy system might be. App-based solutions can address some usability issues without the need to rip and replace current EHR systems.

The digitalization of health records has been a painful journey for most physicians because the needs of clinicians have largely been ignored. Instead of being a tool for physicians, EHRs have become a task. By committing to fix EHR usability, we have the opportunity to diminish physician frustrations and give them the chance to stay focused on the delivery of quality patient care.

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Currently there are "3 comments" on this Article:

  1. This is like that other article where the author describes the symptoms of the problem then tiptoes around identifying the actual problem to their own benefit.

    Doctors are burned about because they have increasing demands put upon them by their management as well as increasing market pressure. This is the source of burnout for pretty much all workers regardless of industry. Many of these demands are implemented through the EHR, especially in health systems, large hospitals and medium large medical practices. Doctors have to do more work for the same amount of patients/dollars. Until that situation is resolved, the suggestions in this article will be only minor improvements.

    Thinking about the situation for two seconds, many healthIT discussions about burnout make no sense. Has burnout among medical assistants increased a huge amount since EHRs or EHR heavy requirements were put in? Not really, so the source here is probably not the EHR. What’s the rate of burnout among VA staff, who have an EHR that on the clinical side is hugely unusable? It’s about 1/2 that of elsewhere. So it doesn’t seem like the EHR is a driving factor here. Why does your job suck? Probably management. If management came by with a survey asking why your job sucked, would you check the box that says “management sucks”? Only if you were a baby in the corporate world.

  2. Boy do I love platitudes! Like “Adopting app-based solutions” and “Promoting interoperability”. Okay. Which APIs should we standardize around, and why? Which term dictionaries? How should we account for patient privacy as apps get more access to data? How does involving physicians help if there are immovable regulatory obstacles?

  3. mmm, let me guess, MediComp can provide the appropriate solution to all the ill wills of current EHR’s. Better yet, lets go back to paper.

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