President's Message: EHRs Aren't Making Our Job Easier or Our Patients Better
A few weeks ago, I had the opportunity to attend a conference where physicians and administrative leaders gathered to discuss strategies to improve workflows and potentially reduce the impact of the electronic health record on physician burnout. During the icebreaker, we were asked to introduce ourselves by stating our names, titles, and sharing a challenge with the EHR each of our organizations have seen. The hope was to see if any other organization had experienced your challenge and could provide some ideas regarding solutions that your organization could implement.
When it was my turn to speak, I introduced myself and stated that I did not mean to sound cynical, but it was really amazing (well, unbelievable, actually) to me that a group of leaders had flown in to gather to try to overcome challenges with our EHRs.
How did we get here? The challenges are so big that we have to pull clinicians away from patient care to strategize on EHR work arounds. How did we let this happen?
Technology always seems to be advancing faster than we can keep up — except when it comes to electronic health records. The Agency for Healthcare Research and Quality has identified physician burnout (a long-term stress reaction marked by emotional exhaustion, depersonalization, and a lack of sense of personal accomplishment) to be caused by several factors in the health care environment, including the EHR.
It is important to understand that EHRs were initially built to maximize billing. The potential to share information quickly between health professionals and health systems and improve care coordination, communication, and efficiency motivated policy makers and health systems to adopt EHRs. I still remember going up and down the floor to locate a patient chart, review vitals, put in orders, and enter my note before rounds — how great it was to finally be able to just sit at a computer and have all of that information at my fingertips and get my notes done much more efficiently!
But the promise of convenience soon became overshadowed by the volume of electronic tasks — patient emails, FYI and “please advise” inbox communications, urgent refill requests, prior authorizations, orders, referrals, electronic triage, and thousands of clicks. Then, policies were adopted that incentivize health systems to adopt EHRs or penalize them if they don't. Despite billions of dollars spent investing in them, EHRs haven’t lived up to their potential. The technology never advanced the way it should have — different systems don’t talk to each other, more layers have been added, and as a result physicians often spend more than a third of their time in the exam room navigating the EHR.
We are spending more time doing desktop medicine and less time with direct patient care. It is estimated that physicians spend about 50% of their time navigating their inboxes and EHR load, and just 27% percent of their time in direct patient care. Studies have shown that for every one hour of patient care, that leads to two hours of desktop medicine. It’s no wonder that challenges with EHR usability impact health professionals and contribute to burnout.
One study showed that almost 70% of physicians surveyed said that EHRs add stress to their jobs and also that they do not improve job satisfaction. Physicians experiencing burnout are reducing their clinical time, retiring early, or walking away from medicine altogether — yet there is no movement to demand EHRs that actually work for us.
The EHR still largely serves as a billing tool but is now also a way for insurance companies to measure metrics that are used to incentivize — or penalize — physicians. At the conference I attended, my colleague shared an analogy about what we have received: Working with tech companies that produce and update our EHRs is much like working with a contractor who is building your home. This EHR contractor, however, decided to create their own building plan and now we are stuck living in a house that we would never buy.
So, what can and should be done?
The reality is that because of the EHR mandates, we were essentially given the basic technology and told to work with it. Physicians missed the opportunity to take charge and build a system that truly worked for them and their patients. That’s what we have to do now: it’s up to us to advocate strongly for systems that shift the focus of EHR development and improvement from billing and metrics to improved clinician usability and decreased EHR time. It’s time for developers to cut down on clicks. And physicians need protected — and reimbursed — time to address the excessive asynchronous care.
With all of the technological advancements we have seen over the years, it’s astounding to me that EHR usability has not improved significantly over time. Physician satisfaction has to have the same impact on health systems that patient satisfaction surveys do. The only way things change is for physicians to come together and speak with a collective voice.
In the meantime, there are some little ways to improve your EHR experience at the local level. The American Medical Association has compiled the Taming the Electronic Health Record Playbook to help. It recommends ways to cut down on the unnecessary work and to share the necessary work. You can access the playbook here.
Before I go, I want to say thank you to the SSVMS board and staff for all they have done to support me for their work on the key issues I wanted to focus on this year, including physician burnout, physician wellness and retention, and health equity. I look forward to continuing my service on the board as immediate past president and know that our new president, Vanessa Walker, DO will do a fantastic job in the coming year. I also want to thank our members for doing so much to support our community, our Medical Society and each other. Thank you for allowing me to serve as your president, and let’s look forward to a great 2024.
J. Bianca Roberts, MD - jbiancaroberts@gmail.com
