It has become a common sight – doctors with their laptops or tablets, conversing with patients while navigating through EHRs (Electronic Health Records), searching and typing. Does the widespread use of Electronic Health Records 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 Electronic Health Records Problems.)
Most doctors don’t love their Electronic Health Records systems!
In general, it’s safe to say that most doctors have issues with EHRs. There have been many recent studies evaluating how doctors feel about the use of EHRs, and the results are generally not positive. Research has found:
- 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 per patient encounter using EHRs, 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 are generated by EHRs? 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. Additionally, EHRs may help reduce medical errors.
Why should we be concerned about doctors’ opinions of EHRs?
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, stress can 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.
If you need to obtain copies of all your medical records, read Tips for Getting Copies of Your Medical Records for tips.
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. Even more so if your doctor has his/her nose buried in his/her computer. For specific recommendations, read my blog posts:
- Patient-Doctor Communication: What’s the Impact on Patient Health?
- 10 Tips to Communicate Better with Doctors.
- Why Take Detailed Notes at Doctor Appointments?
For more tips for getting better care, read these blog posts:
- Understanding Medical Information Is Harder Than Most Realize.
- 10 Tips for a Better Medical Appointment.
- Being an Engaged Patient Can Help You Get the Best Medical Care Possible
- The Pros and Cons of Electronic Health Records.
- Is Doctors’ Stress and Burn-Out Something Patients Should Care About? Yes!
NOTE: I updated this post on 1-15-20.