office physicians have different opinions about electronic records

A new study reports widespread agreement among physicians that maintaining electronic health records (EHRs) undermines their connection with patients. The analysis found, however, that hospital-based physicians most often decried how EHRs take time away from patient contact, while office-based physicians most often lamented that EHRs detract from the quality of their patient interactions.

The analysis by researchers at Brown University and Healthcentric Advisors, novel for its relatively large sample size and its incorporation of both hospital and office-based physicians, is based on the open-ended answers that 744  gave to this question on a Rhode Island Department of Health survey in 2014: “How does using an EHR affect your interaction with patients?”

The survey question was optional but hardly trivial, said study co-author Dr. Rebekah Gardner, an associate professor of medicine at the Warren Alpert Medical School and a senior medical scientist with Healthcentric Advisors. With the goal of improving the quality of care, federal “Meaningful Use” standards have vastly expanded the amount of information that doctors must capture. But the American Medical Association has raised concerns about EHR software usability, and studies have shown that the burden of meticulously filling out  is a major cause of physicians experiencing burnout, a discouraged form of emotional exhaustion and depersonalization in their work.

“Physicians who are burnt out provide lower-quality care,” Gardner said. “What this speaks to is that we, as physicians, need to demand a rethinking of how quality is measured and if we’re really getting the quality we hoped when we put in EHRs. There are unintended consequences of measuring quality as it’s currently being done.”

Gardner also cited research indicating that patients who feel their doctors don’t understand them or communicate poorly are less likely to stick with treatments and engage in follow-up visits, which can undermine their care.

In highlighting how EHRs impose different burdens on different physicians, the study in the Journal of Innovation in Health Informatics illustrates that EHRs pose a multifaceted set of problems for medical practice, she said. Even so, doctors responding to the survey also acknowledged that EHRs are both here to stay and provide important benefits, such as ready access to information.

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