During the past decade, America's physicians -- particularly, family physicians -- have invested lots of money and countless hours in implementing electronic health record (EHR) systems.
Some physicians eagerly dived into the EHR pond; others were pushed by government initiatives, such as meaningful use, that were intended to spur technology uptake but that have become increasingly burdensome to physicians.
Now, a new report(www.americanehr.com) titled "Physicians Use of EHR Systems 2014" shows that when compared with a similar survey five years ago, physicians' satisfaction with their EHRs is declining.
For instance, in 2010, 61 percent of respondents said they were "satisfied" or "very satisfied" with their EHRs, compared with just 34 percent in 2014.
Furthermore, of physicians who responded to the 2014 survey,
- 55 percent said it was difficult or very difficult to use their EHR to improve efficiency,
- 72 percent said it was difficult or very difficult to use their EHR to decrease workload,
- 54 percent indicated that their EHR system increased their total operating costs, and
- 43 percent said they had not yet overcome productivity challenges associated with implementation of their EHR.
- A recently released report shows physicians became increasingly dissatisfied with their electronic health record (EHR) systems between 2010 and 2014.
- In 2010, 61 percent of respondents said they were "satisfied" or "very satisfied" with their EHRs, compared with just 34 percent in 2014.
- An AAFP health IT expert suggested that implementation of the meaningful use program led to a general groundswell of dissatisfaction with EHR products.
Report authors put it this way: "From the physicians' perspective, it appears that the significant investment in EHR system(s) over the past few years in the United States is failing to offer significant returns. Far from helping physicians to operate efficiently and have more time to spend with patients, the opposite appears to be the case."
The report, based on 940 respondents, was compiled by AmericanEHR Partners and the AMA, in association with the AAFP and the American College of Physicians (ACP).
Notably, more than half of responding physicians practiced in primary care specialties defined as general practice/family medicine (25 percent), internal medicine (22 percent), pediatrics (5 percent) and OB/Gyn (5 percent). Physicians practicing subspecialty care represented about 41 percent of respondents; 2 percent did not identify their medical specialty.
Physicians completed online surveys between May 30, 2014, and July 18, 2014.
Did Meaningful Use Hasten Dissatisfaction?
Steven Waldren, M.D., director of the AAFP's Alliance for eHealth Innovation, suggested that the meaningful use program led to a general groundswell of dissatisfaction with EHR products.
"Meaningful use accelerated the addition of increased functionality in EHRs, and vendors didn't have time to integrate those new functionalities into physicians' work flow," said Waldren in an interview with AAFP News.
He pointed to a report bar graph detailing the stair-step decline in EHR satisfaction rates from 2010 to 2014. Stage one of meaningful use was implemented in 2010-12; stage two began in 2014 and is ongoing.
Waldren explained how meaningful use requires specific measurement of a physician's work and used the "patient smoking status" criterion as an example.
"To achieve meaningful use, physicians have to record smoking status on a certain percentage of patients; many AAFP members have told me they already were collecting a more detailed tobacco history using their own customized forms," said Waldren.
However, when family physicians entered data from their custom form into the EHR, they found that the EHR offered a series of boxes to be checked for meaningful use compliance.
"So if the physician entered information from a customized flow sheet for the meaningful use smoking status measure, it didn't count; physicians were doing double the work entering their own custom flow sheets and then checking off the meaningful use boxes," Waldren explained.
"At that point, physicians had three options. They could fail meaningful use, do double work or quit using their own customized forms that -- according to the members I've talked to -- were far more comprehensive that what was implemented by EHR vendors for meaningful use," he said.
Despite this pronounced vendor oversight, Waldren cautioned there was more to the story.
"Tight meaningful use timelines laid out by CMS rulemaking made it difficult for vendors to accomplish robust implementation," he said.
In other words, vendors had deadlines to meet, and so they rolled out the simplest designs they could to effectively meet the letter of the law.
"Unfortunately, those products rushed to market did not have physicians' best interests in mind. What's been missing too often in vendor products is great functionality and a rich user experience that fits with the work the physician is trying to accomplish," said Waldren.
"Even without meaningful use, we would have usability challenges, but meaningful use certainly put a spotlight on the inadequacies of current products," said Waldren.
"And then add the lack of interoperability among products, and it just contributes to user dissatisfaction," he added.
Authors Round Out Findings
According to an Aug. 10 press release(www.acponline.org) from the ACP, the 2014 survey indicates that there's much more work to be done on the EHR front.
"While EHR systems have the promise of improving patient care and practice efficiency, we are not yet seeing those effects," said Shari Erickson, M.P.H., vice president of the ACP's division of governmental affairs and medical practice.
"We need to focus on figuring out how we can help physicians and practices to more effectively implement and use these systems," she added.
Report authors suggested that perhaps the decline in EHR satisfaction was linked to the length of time a physician had been using a system.
"In general, respondents were less satisfied with specific functions and less likely to report a positive impact during the first three years they used an EHR system," wrote the authors.
"A majority (60 percent) of those respondents who reported that they were dissatisfied with their EHR system had used their system for less than three years; 80 percent had used their system for less than five years," they added.
Authors also pointed to the characteristics of late adopters as another explanation for the decline in satisfaction. They noted that late adopters, in general, were "more skeptical of the technology" and less likely to be "technologically sophisticated."
According to the report, primary care physicians were more likely than subspecialist physicians to express satisfaction with their EHRs or to indicate the system's positive impact on practice.
"This difference is likely explained by the longer period of time, on average, that primary care physicians had used their EHR systems compared to the specialists," said the authors.
The report called on the AAFP, the AMA and the ACP to advocate on behalf of their members -- EHR users -- to help "influence the future direction of both EHR products and the policies associated with meaningful use of these products.
"In particular, these organizations should continue to examine their members' EHR use to identify products and best practices that are producing tangible results and encourage continued refinement of EHR products based on these learnings."
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