November 20, 2019
By Megan Brooks
NEW YORK (Reuters Heath) - Electronic health records (EHRs) as currently designed get a failing grade from clinicians and may be contributing to high rates of burnout, new research suggests.
"The major issue with current EHRs is that they have poor usability," Dr. Edward Melnick of Yale University School of Medicine, in New Haven, Connecticut, told Reuters Health by email.
"Federal incentives for EHR adoption led to hasty implementation of systems that are functional and reliable but not yet usable as intended," said Dr. Melnick, who heads the Yale-VA Clinical Informatics Fellowship Program.
"To fix these issues, increased collaboration between vendors, policymakers, technology purchasers, physicians, and patients will be essential to better understand patients' and physicians' needs and design systems that meet these needs," he added.
Among 870 doctors who responded to a survey on EHR usability, the average score on the System Usability Scale (SUS) was 45.9 (out of a possible score of 100), which is in the "not acceptable" range, Dr. Melnick and colleagues report in Mayo Clinic Proceedings, online November 14.
"The usability of current EHR systems received a grade of F by physician users when evaluated using a standardized metric of technology usability," Dr. Melnick told Reuters Health.
In multivariable analysis adjusting for age, sex, medical specialty, practice setting, hours worked, and number of nights on call weekly, physician-rated EHR usability was independently associated with the odds of burnout. Each 1-point more favorable SUS score was associated with a 3% lower likelihood of burnout (odds ratio, 0.97; P
"We know that physicians are frustrated with their EHRs and that EHRs are a driver of burnout. This is the first study to measure these issues nationally," said Dr. Melnick.
The study also found that certain physician specialties rated their EHRs especially poorly, including dermatology, orthopedic surgery and general surgery. Conversely, specialties with the highest ratings included anesthesiology, general pediatrics and pediatric subspecialties.
Demographic factors like age and location also mattered; older physicians found EHRs less usable, and doctors working in veterans' hospitals rated their EHR higher than physicians in private practice or in academic medical centers.
Research has shown that doctors spend one to two hours on EHRs and other desk work for every hour spent with patients and an additional one to two hours daily of personal time on EHR-related activities.
"As recently as 10 years ago, physicians were still scribbling notes," Dr. Melnick said in a statement. "Now, there's a ton of structured data entry, which means that physicians have to check a lot of boxes. Often this structured data does very little to improve care; instead, it's used for billing. And looking for communication from another doctor or a specific test result in a patient's chart can be like trying to find a needle in a haystack. The boxes may have been checked, but the patient's story and information have been lost in the process."
Commenting on the study in a statement, Dr. Patrice Harris, president of the American Medical Association (AMA), said the findings "will not come as a surprise to anyone who practices medicine. Too many physicians have experienced the demoralizing effects of cumbersome EHRs that interfere with providing first-rate medical care to patients."
"It is a national imperative to overhaul the design and use of EHRs and reframe the technology to focus primarily on its most critical function - helping physicians care for their patients," writes Dr. Harris. "Significantly enhancing EHR usability is key and the AMA is working to ensure a new generation of EHRs are designed to prioritize time with patients, rather than overload physicians with type-and-click tasks."
"Through its ongoing work, the AMA is committed to help physicians and their practices thrive so they can continue to put patients first," she adds. "Through our research, collaborations, advocacy and leadership, the AMA is working to make the patient‐physician relationship more valued than paperwork, preventive care the focus of the future, technology an asset and not a burden, and physician burnout a thing of the past."
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