Survey results released by AmericanEHR Partners and AMA indicate declining satisfaction with EHRs compared to five years ago, with about half of the respondents reporting a negative impact on costs, efficiency or productivity.
The 2014 survey found only 34% of respondents satisfied or very satisfied with their EHR system, while five years ago it was 61%.
Why the decrease? The report suggests that it takes at least three years for respondents to overcome the initial challenges of adopting a new EHR and to derive many of the benefits.
“It may be that as we see more practices that have been using these systems longer we will see satisfaction begin to rise,” suggests Shari Erickson, MPH, Vice President of ACP’s Division of Governmental Affairs and Medical Practice, in the group’s survey announcement.
Other healthcare experts propose further explanations and solutions.
A need for optimization
While physicians have had the patience to get systems implemented for Meaningful Use and other initiatives, that patience may have worn thin over time if they never optimized their use of those systems, says Robin Settle, partner at Kurt Salmon’s Health Care Information Technology Practice. She suggests it’s time for hospitals and practices to continue their investment in these systems, and not to jump ship, because the rumblings are similar across most systems.
Settle recommends that organizations reassess whether their issues are with IT, operations, training, and related factors so improvements can be implemented. She notes that providers often give up on submitting issues to their help desk after a year or two because they feel it doesn’t help.
“I think in many of these organizations there needs to be a concerted optimization program,” she says.
Settle also advises the removal of old legacy systems that people tend to use as a crutch, and looking at whether they have simply put EHRs on top of old processes rather than evolving their processes.
Stifled enhancement
Another issue impacting physician satisfaction with EHRs comes after the usual adoption and learning have passed, and a comfort level has been obtained with basic functionality, suggests John Hoffstatter, delivery director, Clinical Advisory Services, CTG Health Solutions.
After that point, physicians often experience difficulty as they seek to improve functionality, and run up against limits of their EHR vendors due to regulatory and compliance requirements. “Caught between technical wants to improve EHR effectiveness and technical compliance maintenance, it’s no surprise that physicians are frustrated. The problem is likely not going away any time soon,” Hoffstatter told Healthcare Dive.
Further, if physicians are unable to leverage data from their EHRs, they are unable to obtain a return on their investment, he says. “Combined with the initial EHR adoption incentive dollars drying up, the ability for physicians to achieve a return on their investment (a.k.a. compensation from using their EHRs) is a necessity that has become more difficult to meet.”
He adds that physicians are also being asked to adopt evolving population health management tools, which adds to the workflow change. “Unfortunately, while waiting for the industry to develop robust and proven technologies, physicians are caught in the middle attending to their patients while being held to a higher level of tech user accountability supporting the PHM movement,” Hoffstatter says.
The technology is getting in the way
While decreased productivity is a chief concern, that’s not all of it, Dr. Roy Smythe, chief medical officer at AVIA Health, tells Healthcare Dive. The issues he sees are that EHRs require a new way of working, and that they get between the doctor and the patient. Healthcare has gone from a time of focusing on the patient, to a time in which physicians are spending a significant portion of each visit looking at a computer screen.
“It’s a fundamentally different experience, particularly for those who have been practicing for decades,” Smythe says. So while it’s typically thought of as a workflow issue, “There’s also this existential thing about technology getting between you and the patient, and it’s real for a lot of doctors,” Smythe says.
He sees this as a time of transition, like others that have come before. As he outlines in a recent Forbes article, history saw productivity challenges during the early adoption of electricity and computers as well. It will take new ways of thinking about how to use EHRs, as well as refinement of the technology, before we can expect to reap the benefits, he says.
Smythe does see some of that refinement on the horizon, such as voice recognition technology that would automatically record a patient visit and format the data in the EHR, allowing the physician to once again focus on the patient. That alone would be a game changer, Smythe says.
While there is light at the end of the tunnel, this is of little consolation to those who won’t be practicing by the time these refinements come around, Smythe notes. Things are not going to change enough over the next few years to make healthcare feel like it used to feel.
However, as trite as it may sound, he says, he reminds physicians that the efforts of today are key to the future of healthcare, as technology evolves to make insights, predictions, and other advancements to improve care.
“When we enter healthcare we all know that there are sacrifices we’re going to make,” Smythe says, “and this is a really important one.”