Electronic health records that stymie physician workflows, impede patient care and erode professional satisfaction are undermining the adoption of new health care payment and delivery models, according to an AMA-sponsored study highlighted March 11 in a Health Affairs blog post.
The study gathered data from 30 physician practices in six states to inform the AMA’s approach to one of its core strategic objectives: Enhancing practice sustainability and professional satisfaction in the evolving health care system.
Through open-ended interviews, investigators from nonprofit research group RAND Corporation detected unexpectedly intense concerns related to electronic health records (EHR), according to the Health Affairs blog post, written by three of the study authors: Mark Friedberg, MD; Jay Crosson, MD; and Michael Tutty, PhD.
Physicians’ perceived ability to deliver high-quality care is the primary driver of their professional satisfaction, and many EHR systems undercut patient care in several ways, the researchers explained.
Concerns included EHR interference with face-to-face patient interactions, software that does not align with workflows, and systems requiring physicians to do burdensome data-entry tasks that a clerk or transcriptionist could accomplish. The inability of many EHR systems to exchange health information electronically has been “deeply disappointing” to physicians, the researchers wrote, while higher than anticipated costs have raised questions about the systems’ long-term sustainability.
Despite these issues, fewer than one in five physicians would go back to paper charts, the study found. Interviews confirmed that physicians are not “luddites, technophobes or dinosaurs,” and that they see the benefits and promise of EHRs. Physicians’ acceptance of this technology is in line with systemic changes, such as meaningful use rules. As the blog authors put it, physicians face an unprecedented “universal mandate” to implement the technology, even though the medical community argues EHRs have not yet reached an acceptably high level of performance.
The AMA is pursuing a number of steps to address this situation, including collaborating with EHR vendors to improve usability and workflow efficiency, and engaging regulators about the pace of the meaningful use program and liability issues related to non-physician staff interacting directly with EHRs.
The transition to EHRs also provides an opportunity to “fundamentally rethink” the way medical records are designed and function, the blog authors stated. For example, wikis and similar multiple-author digital documents could eliminate the replication of inaccurate or superfluous information that occurs when physicians write separate encounter notes.
This ambitious plan for improving EHRs is only one way the AMA is building on the RAND study. For the study findings to be “transformative,” the AMA will work broadly to address the “pain points” it identified for both physicians and patients, AMA President Ardis Dee Hoven, MD, recently wrote.
Learn more about how the AMA plans to shape delivery and payment models for sustainable practices that promote better outcomes for patients and greater satisfaction for physicians.
