To realize the benefits of evidence-based medicine, physicians need to be freed from inefficient EHR systems.
Health care delivery has changed significantly over the last decade with the widespread adoption of electronic health records (EHRs). Unlike their paper-based counterparts, EHRs integrate disparate functions like billing, compliance, clinical ordering, and charting into a single system.1,2 By attempting to align these functions, EHRs promise to improve the quality and efficiency of health care by facilitating information sharing and care coordination.1,3 But instead of promoting seamless efficiency, the system has drastically added to physicians’ burdens and increasingly pulled them away from patient care.
The rapid transition away from paper-based records was fueled by the 2009 economic stimulus package (American Recovery and Reinvestment Act), which created financial incentives for hospitals and providers to adopt EHRs.1,2 Today, almost all hospitals and more than 80% of outpatient clinics use certified EHRs, which is a marked increase from the 10% of hospitals and 40% of outpatient clinics using rudimentary EHRs in 2008. 1 Unfortunately, hurried EHR implementations often prioritized administrative functions over system usability and thoughtful integration into clinical workflows.1,2 Left with cumbersome, time-consuming user interfaces, physicians have borne the brunt of the transition to EHRs, which now consistently rank among the top causes of today’s epidemic rates of physician burnout.2,4,5
It’s easy to see why physicians are frustrated. By some accounts, more than two-thirds of the time physicians spend on EHR tasks is unrelated to medical care.6 When physicians spend two hours on EHR clerical tasks for every hour of direct patient care, it’s no wonder physicians feel more like data entry clerks than clinical specialists.6
System changes are urgently needed to free physicians from the burdens of inefficient user interfaces and data entry. The full potential of EHRs can only be realized when physicians can embrace them as useful tools that support the care process without them being an unwelcome and timewasting distraction.2 As publishers of clinical practice guidelines, MDGuidelines envisions a future where EHRs can be adapted to quickly and efficiently meet the well-documented information needs of physicians in clinical practice.7 Currently, doctors spend only 1% of their time using the clinical practice guidelines that are currently accessible through EHRs, primarily because the existing system is too unwieldy and arduous to navigate.6 Emerging voice-driven user interfaces and the promise of artificial intelligence technologies that proactively search, sort, and present information to the physician on command are promising innovations. It’s time for EHRs to serve doctors, not the other way around.
The digitization of our massive health care system over the last decade is nothing less than extraordinary, but we are at a turning point. The next generation of EHR systems needs to be built around the clinical needs of physicians so that it supports physician-patient interaction rather than impede it.
- Washington V, DeSalvo K, Mostashari F, Blumenthal D. The HITECH era and the path forward. New England Journal of Medicine. 2017; 377(10):904-6. doi: 10.1056/NEJMp1703370.
- Watcher R, Goldsmith J. To combat physician burnout and improve care, fix the electronic health record. Harvard Business Review. https://hbr.org/2018/03/to-combat-physician-burnout-and-improve-care-fix-the-electronic-health-record Accessed June 19, 2018.
- Institute of Medicine. Crossing the quality chasm: a new health system for the 21st Washington, DC: National Academy Press, 2001.
- Lee ME, Brown DW, Cabrera AG. Physician burnout: An emergent crisis. Progress in Pediatric Cardiology. 2017;44:77-80. http://dx.doi.org/10.1016/j.ppedcard.2016.11.006
- Friedberg MW, Chen PG, Van Busum KR, et al. Factors affecting physician professional satisfaction and their implications for patient care, health systems and health policy. Rand Corporation. http://www.rand.org/pubs/research_reports/RR439.html. Accessed June 19, 2018.
- Arndt BG, Beasley JW, Watkinson MD, et al. Tethered to the EHR: Primary care physicians work load assessment using EHR event log data and time motion observations. Ann Fam Med. 2017; 15:419-426. https://doi.org/10.1370/afm.2121
- Del Fiol G, Workman E, Gorman PN. Clinical questions raised by clinicians at the point of care: a systematic review. JAMA Intern Med. 2014; 174(5):710-718. doi:10.1001/jamainternmed.2014.368