- Researchers from the Mayo Clinic and Cleveland State University have pinpointed challenges contributing to physician dissatisfaction with EHR use.
A team led by the Mayo Clinic Division of Hematology's Tait Shanafelt, MD, conducted a national survey of US physicians between August and October 2014 on the subject of EHR use, computerized physician order entry (CPOE), and patient portal for the purposes of studying physician burnout caused by health IT.
Of the 6,375 physicians participating in the survey, a sizeable majority (4,858; 82.5%) reported CPOE use as part of their EHR experience. According to the findings of Shanafelt et al., CPOE or EHR use was tied to lower physician satisfaction as a result of the time spent on clerical tasks as well as higher rates of physician burnout. CPOE use, in particularly, correlated with higher rates of physician burnout as compared to EHR use alone.
"Electronic health records hold great promise for enhancing coordination of care and improving quality of care," Shanafelt told Science Daily. "In their current form and implementation, however, they have had a number of unintended negative consequences including reducing efficiency, increasing clerical burden and increasing the risk of burnout for physicians."
Specialties with lower satisfaction and great risk of physician burnout were family medicine, urology, otolaryngology, and neurology.
"Burnout has been shown to erode quality of care, increase risk of medical errors, and lead physicians to reduce clinical work hours, suggesting that the net effect of these electronic tools on quality of care for the U.S. health care system is less clear," Shanafelt added.
Shanafelt was part of a team of researchers behind a 2011-2014 study in conjunction with the American Medical Association that indicated a ten-percent spike in reported physician burnout over that period across all specialties.
For researchers at three universities, including Cleveland State, a culture of silence is a contributing factor as well.
“There has been a lot of data collected about EHRs but little analysis of how the people using the technology actually feel about it,” said Tracy Porter, co-author a study to be present at the Academy of Management's upcoming annual meeting. "Our work indicates that there are clear problems being identified by the EHR user but due in part to workarounds and the culture of silence these issues are not being properly addressed, reducing the benefits of the technology and potentially leading to additional problems.”
The qualitative study analyzed physician perceptions of EHR technology and identified several challenges for physician EHR use:
- increased workload
- data accuracy and integrated
- over-reliance on technology
- user training.
The team of researchers found EHR dissatisfaction as the impetus behind various physician workarounds. Additionally, physicians were hesitant to speak out about EHR-related challenges.
Current AMA President and emergency physician Steve Stack, MD, spoke at length about EHR-related physician burnout with EHRIntelligence.com in March. He chalked up physician EHR dissatisfaction to a lack of usability stemming from poor EHR design.
Listen to the Xtelligent Media Podcast with AMA President Steve Stack, MD
"Electronic health records have a great amount of promise," he explained. "Many doctors actually enjoy a lot of facets of their EHRs — the ready access to information, the ability to see historical information, the ability to share information with other doctors, other clinicians, and their patients directly so that patients can be more informed. Those are all good things, but there are many other aspects of the EHR that are frustrating. They are inefficient to use. They don't talk to each other. They cost a lot of money. When they crash or go down, it paralyzes our ability to do our work and care for patients."
According to Stack, EHR efficiency (or lack thereof) was requiring physicians to spend free time on clinical documentation.
"We use incredible surgical tools to do things today that were science fiction 100 years ago for sure, 50 or 25 years ago for much of what we do," he emphasized. "When we then turn to electronic health records and we explain that we are frustrated that the tools make us less efficient — that the mandates have turned us in to secretaries and clerks instead of efficient and high-performing physicians, when we say that the electronic health record takes us away and robs us of time to spend with our patients and that it's a frustration for the doctor and for the patient — we then get very consternated."
Based on these studies, relief has yet to come to physicians.