How To Ease EHR Frustration
EHRs can slow physicians' practices to a crawl, but evidence suggests they ultimately pay off.
But doctors still complain about one shortcoming: These tools can impede their productivity, reducing the number of patients they can see each day.
In a survey posted by AmericanEHR Partners, a collaboration between the American College of Physicians and software vendor Cientis Technologies, one respondent complained, "It takes twice as long to complete a patient's visit, and I see 75% of the patients now as compared to before EHR." Another survey respondent--a young, computer-savvy doc--griped about having to click too many times and switch among multiple screens: "The EHR makes every aspect of the work involved with patient care take MUCH longer than it did before."
[ Practice management software keeps the medical office running smoothly. For a closer look at KLAS' top-ranked systems, see 10 Top Medical Practice Management Software Systems. ]
Careen Whitley, a family practice doctor with Hill Physicians in Oakland, Calif., noted that before she started using an EHR, she was seeing about 35 patients a day. This dropped to 15 during system implementation, then went back up to 20 during the next six months. Speaking at a recent meeting of the Office of the National Coordinator for Health Information Technology, Whitley still gave EHRs an overall positive evaluation. "The efficiencies of EHR are not in the time spent by the provider, but rather in the more efficient use of ancillary staff, decreased redundancies, and instant availability of patient data," she said.
But some clinicians have been so frustrated working with EHRs that they're advising colleagues to take the penalty for not implementing one--a 1% reduction in reimbursements by 2015 from the Centers for Medicare and Medicaid Services.
Is that extreme reaction justified? Whitley's experience, as well as research from independent sources, suggests not.
One study, by Hemant Bhargava, professor of management and computer science at the UC Davis Graduate School of Management, and his colleagues looked at the productivity of about 100 physicians who use an EHR system. The researchers found that the physicians' productivity dropped initially by as much as 33% but after a month came back up to near preinstallment levels.
Digging deeper into the productivity stats, Bhargava's team discovered that internists fared better than pediatricians and family practitioners. The researchers theorized that EHRs, because they can efficiently display stored data, are better suited for internists, who rely heavily on data review to reach a diagnosis. Pediatricians and family docs, on the other hand, do more data entry and documentation, which is still quite time-consuming with electronic records, especially when the system requires lots of drop-down menus, screens, and mouse clicks.
One obvious solution is for clinicians to find an EHR vendor that understands their specialty and tailors its product to fit the specialty's workflow. But that's only part of the answer. Clinicians complain about poor vendor support once the system is installed, or support that's too expensive. Buyer beware. Healthcare IT managers must get physicians and nurses involved at the very beginning of the EHR planning process.
Consider these three resources:
--KLAS. This advisory firm does independent evaluations of health IT systems and services, including their vendors, collecting feedback from thousands of end users. For instance, a February 2012 KLAS report looks at EHRs in 15 specialties.
--The American Medical Association. Consult the AMA's 15 questions to ask before signing an EMR/EHR agreement, as well as its Amagine service.
--AmericanEHR Partners. Mentioned earlier in this column, AmericanEHR Partners provides side-by-side comparisons of EHR products.
Clinicians often have good reason to be annoyed with EHRs. But doing a thorough analysis of your system options, and having the patience to move up the learning curve once the system is installed, will make the journey less aggravating.
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