It has become a common sight – doctors with their laptops or tablets, conversing with patients while navigating through Electronic Health Records (EHRs), searching, and typing. What do doctors think about Electronic Health Records? Would you be surprised to hear that EHRs add to doctors’ stress?
EHRs have certainly impacted the type of interactions we have with our doctors. Do EHRs make it hard for doctors to maintain eye contact with their patients? Do they make it harder for doctors to listen carefully to their patients?
I have had both positive and negative interactions with my doctors as they use EHRs over the years, and I assume many of you share my experiences.
EHRs supposedly help doctors keep track of each patient’s health, while allowing electronic record sharing between doctors on the patient’s medical team. And patients can easily access their own records. But are EHRs a blessing or a curse for doctors?
Many signs point to a negative impact of EHRs on the stress levels and time demands of doctors. And EHRs are not foolproof and can lead to medical errors (for more information, read 6 Dangers of Electronic Health Records.)
What do doctors think about Electronic Health Records?
In general, it’s safe to say that most doctors have at least some negative opinions about EHRs.
Certainly, there are advantages to Electronic Health Records (EHRs). Doctors can review past exam records and medication lists, access test results, and see notes from other doctors who are using compatible systems.
On the other hand, the use of EHRs can dramatically change the quality of the conversation and appointment, as much time can be spent navigating the system, entering data and checking it for accuracy. Some patients report frustration that there is less eye to eye contact as doctors are focused on their screens.
For instance, the strict data entry categories in EHRs can limit the scope of information added by the doctor, which can frustrate doctors and impact care. One doctor interviewed on this topic reports the EHR system she must use include lists of diagnoses, symptoms, and physical exam findings.
She reports frustration with the inability to record her opinions or findings on how each patient’s symptoms relate to other symptoms or events, and her thought process in coming to a coherent narrative. Additionally, she thinks her EHR makes it hard for her to record the patient’s experience and her observations over time.
Furthermore, many doctors think EHRs ruin the doctor-patient relationship. For instance, in a recent survey, doctors reported “immense pressures, with bureaucratic tasks and paperwork topping the list”. And the survey found that more than 1/2 of doctors spent at least 10 hours each week on paperwork and administrative tasks.
Studies uncover what doctors think about electronic health records.
Other studies on doctors’ opinions of EHRs show a skew towards negative opinions:
- EHRs are seen as a major cause of distress in the medical profession.
- Doctors spend significantly more time working on their EHRs than they spend with their patients.
- Doctors spend almost 6 hours/day using their EHRs; 4.5 hours while with patients, about 1.5 hours after work hours.
- Over 44% of total time working on EHRs is spent on documentation, order entry, billing and coding, and system security.
- Almost 24% of the time working on EHRs is used for by inbox management.
- On average, doctors spend 16 minutes and 14 seconds using EHRs for every patient they see, with time spent on:
- Chart review (33%)
- Documentation (24%)
- Ordering (17%)
- Doctors report low satisfaction with their EHRs.
- The majority of doctors report they feel EHRs slowed them down.
- Doctors feel the use of EHRs undermines their connections with their patients.
- Doctors who work in hospitals are concerned that EHRs take time away from time spent with patients.
- Office-based doctors reported that EHRs reduce the quality of their patient interactions.
- EHRs have led to an increased risk for professional burnout.
Electronic health records lead to an overload of messages.
Research published in 2019 shows a link between doctors’ well-being and the volume of messages they receive. And it turns out that EHRs are a big part of the problem. Messages generated by EHRs account for almost 1/2 of the messages doctors receive – a far greater number than messages sent by patients and other doctors.
What kinds of messages to EHRs generate? Automated EHR messages include pending orders based on algorithm-driven health maintenance reminders, requests for prior authorization and patient reminders.
It’s not all bad news.
Of course, there are benefits of using EHRs as well. Doctors appreciate that EHRs allow them to look up a patient’s history, communicate with patients through web-based portals, and display educational information for patients.
Why should we care about the impact of EHRs on our doctors’ ability to do their jobs?
As stated above, doctors report that EHRs negatively impact the quality of their patient interactions. This can significantly impact patients since effective patient-doctor communication leads to more appropriate medical decisions and better health outcomes.
In my opinion, it is easy to connect the dots – as doctor-patient interactions suffer, patient health may suffer as well.
Additionally, no one wants treatment from a stressed, burned out doctor. Not only are stressed people often cranky, but stress can also lead to errors, which is clearly a concern when your health is at risk.
Dr. Shanafelt, lead author of a study on EHRs’ impact, states that “Burnout has been shown to erode quality of care, increase risk of medical errors, and lead physicians to reduce [their] clinical work hours.” He continues by stating that it is unknown how EHRs and other electronic tools will impact quality of care.
Lastly, as doctors reduce their work hours, or leave the profession entirely, it will likely become harder and harder to find doctors who can treat you, which is already an issue in many areas of the country.
One more concern – electronic health records are not mistake proof.
Mistakes in EHRs are more common than you think. There are many reasons for mistakes, including typos and auto correct. For your own health and safety, I highly recommend that you ask each doctor for a printout of his/her notes at the end of each appointment, and regularly check your records through your online portals. Notify your doctor if you see any errors.
For more information on this important subject, read Are Your Medical Records Accurate?
Some doctors are going back to old-fashioned paper.
Although EHRs are here to stay, some medical practices are going back to paper records. A large pain clinic with multiple locations in Illinois has “pulled the plug” on EHRs.
The founder and co-medical director, Dr. Prunskis, states: “We felt the level of patient care was not enhanced by an electronic health record. We saw it was inefficient and added nonproductive work to physicians’ time.”
Interestingly, 100% of their employees thought they should stop using EHRs. His institute made this change several years ago and hasn’t regretted it.
What can you do as a patient or family caregiver?
Hopefully, improvements in EHRs, including how doctors enter and review data, will be coming. In the meantime, I hope doctors increase their use of medical scribes that allow doctors to maintain their focus on the patient while a scribe handles the EHR.
No matter how your doctor manages your medical records, it is important for you to have effective conversations with your doctor at every medical appointment. However, this can prove challenging if your doctor has his/her nose buried in his/her computer. For specific recommendations, read my blog posts:
- 10 Tips to Communicate Better with Doctors.
- Why Take Detailed Notes at Doctor Appointments?
- Should You Record Medical Appointments?
If you need to obtain copies of all your medical records, read Tips for Getting Copies of Your Medical Records.
Since doctor stress can impact care, read these posts:
For tips on how to get better care, read these blog posts:
- Understanding Medical Information Is Harder Than Most Realize.
- 10 Tips for a Better Medical Appointment.
- How Can You Get the Best Healthcare? Actively Participate!