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Physician survey: More use EHR, few are satisfied

By Kyle Murphy, PhD

- A new survey shows that electronic health record (EHR) among physicians has grown significantly over the past three years and will continue increase over the next couple of years. The Medscape survey of more than 21,000 physicians across 25 specialties, “EHR Report 2012: Physicians Rank Top EHRs,” provides deeper insight into the systems physicians are using and for what purpose as well as confirms suspicions about the purported and actual benefits of using an EHR.

The first takeaway from the survey is the growth in EHRs. Since 2009 when only 38% of physicians indicated that they were using an EHR, nearly 75% are current users with another 20% planning to implement a system within the next two years. Do the math — that’s a 200% uptick in physician use of EHRs. Three-quarters of physicians have already achieved (44%) meaningful or will attest within the next year achieve (31%). Fourteen percent won’t bother. Of those working with an electronic system, three groups are using them more than all others: internists (28%), family practitioners (25%), and pediatricians (22%). The least likely users belong to rheumatology, critical care (not to be confused with emergency medicine), and plastic surgery.

While the most lucrative vendors are those with the greatest number of users, they are deemed the most user-friendly EHR systems. Epic (22%), Allscripts (10%), and Cerner (9%) are used by more physicians than any other systems. However, those with the highest approval rating (on a 5-point scale: 1 is poor, 5 is excellent) are Amazing Charts (4.22), Practice Fusion (4.04), and the Department of Veterans Affairs Computerized Patient Record System (CPRS, 3.89).The first is the most popular choice among practices of one to six physicians; the third has taken hold of practices between 26 and 100 physicians.

This dovetails relatively well with which practices are drawn to or shy award from the cloud. small practices (1–6 physicians) are more likely to use the cloud than their larger groups, 46% as compared to 26% (26–100+ physicians). However, positive feedback is the result of performance and price: Amazing Charts is the easiest to learn while Practice Fusion is the best value (what’s better than free?).

Vendor satisfaction is leaning in the positive direction. Thirty-five percent scored their interactions with vendors as 3/5 and 27% scored it as 4/5. Majority of physicians will be sticking with their current EHR. Only ten percent indicated that they’d be changing their systems.

In terms of impact, the most significant effect that EHRs had on practices was a negative one. More than a quarter (26%) of physicians indicated that their EHR led to decreased productivity, as compared to 23% and 15% who indicated more efficiency and higher productivity, respectively. The effects of an EHR on the doctor-patient relationship were considerably mixed: 36% positive, 34% no impact, and 30% negative. “Of doctors who said it had a negative impact, a whopping 82% said it was because of less eye contact with the patient; 75% said there was less conversational time,” note the authors of the survey.

Despite the increased use of EHR system, attitudes and procedures haven’t changed much. Physicians generally maintained their perceptions of the EHR before and after its adoption. More than four-fifths of physicians indicate no difference in the number of tests ordered in the practices. “In primary care, there were more physicians ordering a greater number of tests when using an EHR than ordering fewer tests with the EHR,” the authors write. A majority of physicians are dissatisfied with intra-operability and interoperability of their systems: 54% (negative) to 46% (positive). But only a minority is concerned with the effect of EHRs on the privacy of patient information: 23% (yes) to 77% (no).

While more physicians are providing care to their patients with the help of an EHR system, few acknowledge that they’ve realized the benefits that this technology was advertised to supply: better, more efficient care. Perhaps the final rule for Stage 2 Meaningful Use should have contained quality measures for human interaction between physicians and patients. What gives?

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