Viewpoint: 7 factors that negatively impact physicians' EHR use

Physicians experience various factors that negatively impact their EHR user experience and leave them spending more time on administrative tasks than direct patient care, according to an essay published in the Journal of the American Medical Informatics Association.

American Medical Association researchers, led by Michael A. Tutty, PhD, AMA  vice president of professional satisfaction and practice sustainability, outlined seven factors that can negatively influence physicians' experience with EHRs:

1. Government regulations. CMS and ONC's meaningful use program, which rolled out in 2011, required physicians to complete more data entry, beyond what is needed for patient care. EHR vendors also had to make updates to software design, despite lack of evidence that the changes would improve user experience or patient outcomes.

2. Payment and quality reporting. Physicians must use certified EHR systems to participate in the Merit-based Incentive Payment System track of the Quality Payment Program, but "navigating the shifting targets has proven challenging," researchers wrote.

3. Systems interoperability. Progress to improve interoperability has been slow, despite government incentives. Lack of access to patient records creates frustration, delays in care and patient safety risks.

4. Organizational governance. Compliance and risk management policies can instigate the use of workarounds that expose new risks, such as "note bloat," or physicians and organizations' increasing use of copy-and-paste functions in the EHR to maximize efficiency and protect against legal disputes.

5. Implementation and training. There are numerous aspects of implementing a new EHR that can create a negative experience for physicians, including overly cautious or misinformed compliance departments, inadequate allocation of IT resources pre-and-postimplementation and inadequate staffing levels.

6. Practice design and resource allocation. While decisions to use dictation and transcription devices can streamline documentation, the choice to maintain outdated servers or software can cause slow systems or dangerous workarounds. Proper equipment and setup in the exam room enhance efficiency and promote better eye contact and patient engagement.

7. EHR vendor influences. Some vendors don't involve clinicians in usability testing, which can result in software that aims to fulfill billing, payer and meaningful use requirements rather than clinician satisfaction.

The researchers concluded that EHR vendors, regulatory agencies, insurance payers and healthcare organizations must collaboratively understand how the decisions they make surrounding the EHR affect physician satisfaction and patient care.

To access the full report, click here.

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