Studies from the American Medical Association and others have documented that electronic health records systems are a major source of physician stress and burnout. But just what is it about these systems that cause physicians so much frustration?
The Medical Society conducted a member poll in April to find out your insights. A total of 82 responses were received; since not all respondents use an EHR, a total of 62 EHR users completed the survey.
The most commonly used system is Epic, with 69% of respondents. Other systems mentioned more than once include eClinical Works, Allscripts and Modernizing Medicine.
• 27% agreed with the statement, “I’m frustrated using my EHR; it adds much stress to my day.” Another 56% said the EHR adds some stress.
• 66% disagreed with the statement, “The EHR is appropriately designed and organized to optimize medical care.”
• 75% identified “time required for data entry” as an element of the EHR causing the most problems. Other problematic areas indicated were “interoperability with other systems,” 46%; “screen organization does match with clinical workflow,” 39%; and “cumbersome templates,” 37%.
• Only 35% said their systems had become easier to use in the past five years.
The systems clearly have a lot of room for improvement. SLMMS member comments, selections of which are shown following, were insightful about physician concerns.
Complex and cumbersome:
The organization and layout are not intuitive for how physicians think or enter information. Also, there is no way (or it has never been shown to me) to alter the layout to make it conform to how I work. It takes as long, or longer, to find the information I need than to act upon it.
There is too much carryover data making the records difficult if not impossible to read, and the important data is basically lost.
I have to enter countless useless entries that do not improve patient care.
Not customizable enough. Too much clutter making it hard to find the things you use most frequently.
Difficult to find the most relevant issues when reviewing charts.
Glaucoma test results are difficult to view. Cannot open side by side to compare over time.
When requesting a single pathology document from another EHR system, I get 42 pages of redundant worthless information.
Epic has made the process more dangerous by overwhelming me with faxes that used to be sent separately. I have over 200 in my in basket and more every day. Important information will be missed.
Frequency of updates and how they change workflow.
Too cumbersome. Not intuitive or user friendly.
Times that it breaks down.
At least two extra hours per night of charting to document effectively and stay caught up.
The poor functionality of these systems certainly contributes to longer work days and more physician burnout.
Too many clicks to complete task and slow loading times:
Takes way too much doctor data entry time and too many clicks.
Takes many clicks to even get to opening screens, and load times are very slow. Depending on how many times you have to log into EHR, PACS and email per day, you could easily spend over 30 minutes each day just entering passwords and waiting for the various programs to load.
Have to click through many screens and know the eccentricities of the system to access what you need.
Designed for billing and insurance:
It really is designed for billing. It’s all about putting in appropriate codes instead of focusing on the patients’ clinical issues. It does not truly reflect the length and complexity of patient care.
Designed to optimize billing, not patient care.
Less face time:
I spend more time on the computer than in direct patient contact, which is demoralizing and wasteful of my time. The EHR is the biggest source of physician burnout now as it takes us away from the main reason we went into medicine—patient care!
Huge amount of time wasted. Less time for patient interaction.
It diverts time away from patient care.
You cannot be a good doctor and a good transcriptionist and data entry clerk at the same time.
I hate EMR but it is not the EMR itself, it is the black box that separates the physician from the patient.
Lack of interoperability:
Interoperability is a joke. Epic has different “flavors” from hospital to hospital, even within same hospital system.
ALL EMRs should speak to each other
Shortage of training:
If the system is upgraded, it’s expected that I take time out to learn what’s new on a foundation of already minimally functional knowledge. Every other software product has tutorials and plenty of YouTube videos for self-learning, but this is painfully lacking in EHR products.
In conclusion, while many physicians have grown more accustomed to using an EHR, it is still a source of tremendous frustration and a major contributor to burnout. Some doctors cite advantages in that it eliminates paper and makes them more efficient, but in general most physicians feel the EHR system they use is better suited to enhancing billing and coding, and less inclined to improve patient care.