September 06, 2019
Shivani Malhotra, MD FAAFP, associate program director & assistant professor family medicine, and Emily Leviner, MEd, system administrator, both from UAB School of Medicine, recently discussed the adoption rates of electronic health records over the years, and provided strategies for maintaining dynamic partnerships between physicians and health IT, during a session at PCMH Congress 2019 held in Boston, MA.
Ms Malhotra kicked off the session with a brief history of electric health record (EHR). According to her timeline, the use of EHRs began in the 1960s with Dr Lawrence L Weed and The Problem-Oriented Medical Record. The 1970s, brought the first automation and integration of electronic data with lab and pharmacy, as well as implementation of EHRs in the Department of Veterans Affairs. Throughout the 1980s, there was continued development and refinement of electric medical record (EMR), and in the 1990s, less than 18% of US medical practice settings adopted EHR use.
Ms Malhotra focused on 3 specific years in the 2000s—2004, 2009, and 2012. For 2004, she highlighted the establishment of ONC for Health Information Technology. This was established by President George W Bush under the Department of Health and Human Services and aimed at improving quality, reducing medical errors, and reducing costs. In 2009, there was the development of the HITECH Act under President Barack Obama. The goal was to adopt EHR by 2014. Finally, in 2012, during the post-HITECH Act, physician adoption of EHR technology increased by 72% for office-based physicians.
Ms Malhotra noted, “Four out of ten physicians adopted basic EHR systems with certain advanced capabilities.”
Although there was a great increase in the use of the technology, EHR adoption also came with a lot of “growing pains.” It was explained that many individuals felt as though they were data entry clerks, and some even felt defeated.
Despite these feelings of defeat, office-based physician adoption of any EHR has more than doubled from 42% to 86% since 2008. However, according to Ms Malhotra, around “forty-four percent of primary care provides say their primary value of their EHR is digital storage and not a clinical tool.”
According to findings of a Stanford 2018 physician survey presented during the session, doctors do see value in EHRs, however, they often desire substantial improvements.
The findings of the survey suggest, “two-thirds of PCPs (66%) report they are satisfied with their current EHR, but only about 1 in 5 are very satisfied.”
Further findings of the survey show time spent on EHRs were shown to effect patient relationships. Additionally, roughly half of PCPs agree that using an HER detracts from their clinical effectiveness.
“Out of 31 minutes, PCPs report they spend nearly two-thirds of their time interacting with the EHR.”
In order to address these concerns regarding technology in the health care setting, Ms Malhotra and Leviner provided strategies for engaging physicians and maintaining a dynamic partnership with health IT.
“Remember,” they said, “not one-size-fits-all.”
They said that it is important to engage EHR flexibility to make changes at the organization level in order to decrease technical overload for physicians. Further, consistent and logical points for capturing data to enable measurement are important to develop.
The speakers explained that many PCPs desire an improved interface design. More specifically, the top 3 improvements PCPs desire in the short term are:
- Improved EHR user interface design;
- A shift in HER data entry to support staff; and,
- Use of highly accurate voice recording technology that acts as a scribe during patient visits.
In an effort to address these desires, the speakers provided a list of strategies that can be used to improve the user interface. The list of strategies included:
- Rethinking vendor deliverables;
- Minimize scrolling, and streamlining documentation;
- Offer multiple ways to capture documentation;
- Use of a single click for multiple captures; and,
- Work toward creating note-centric documentation.
Additional strategies highlighted included the use of physician feedback. The speakers said that a “physician wish list” is important. This feedback will focus on end user experience and it will optimize clinical workflow.
According to results of a Deloitte 2018 survey focusing on the impact of physician feedback, 34% of physicians said their organization or EHR vendor sought feedback on enhancements and 44% of primary care physicians have been asked for feedback.
The speakers said that “physicians who were asked for feedback on desired EHR enhancement are far more aware of EHR optimization efforts.”
In addition to the prior strategies, the speakers also provided a list of ideas for enlisting physician feedback and sustaining engagement. Their list included:
- Development of cross-department project work teams;
- Utilization of “soft” roll-outs;
- Use of a think “process” versus “workflow;”
- Exploration of different platforms; and,
- Consideration of centralizing some processes.
They noted that it is important to “support the people, not just the technology.”
According to Ms Malhotra and Leviner, enhancing the educational aspect and ongoing communication involved with EHRs is important. They said it is important to try new things and share common goals. Finally, they concluded, it is important to get creative with training and to develop a shared approach.