Electronic Health Record fails the test of physician usability: What can we do?

23 Jan 2020

By Lillian Erdahl

Today I achieved what has been a challenging goal for me, zero tasks in my electronic health record (EHR) inbox. It is unlikely to last for very long, but it feels good to accomplish it even briefly. Much has been done with information technology in the interest of improving the delivery of health care. Not surprisingly, there are positives and negatives to the digitalization of health care delivery. Emerging literature shows that U. S. physicians find the burdens and poor usability of the current systems to be a major source of stress and dissatisfaction. We are spending “pajama time” trying to keep up with the seemingly endless list of tasks generated in our EHR inbox.

Positive aspects of the current EHRs include electronic preservation of clinical data and accessibility of these data, the ability to share data in a timely fashion from one hospital to another when a patient is transferred or referred to another location, and the potential to reduce errors. Negative aspects of current EHRs include that mechanisms for capturing data that are focused on billing rather than clinical care leading to poor usability for clinicians, redundant processes increasing the work of care, and separation of clinical care from the bedside.

There is a crisis of physician burnout and the EHR is a major contributing factor. For example, a recent study published in the Mayo Clinic Proceedings found that physicians overall graded EHR usability at an “F”. In addition, individual EHR usability ratings correlated with reporting of burnout. Not only are rates of burnout high, the physician suicide rate in the United States is more than double that of the general population. Yet, the health care industry fails to provide user-centered delivery of healthcare including EHR systems that physicians find difficult to use. We must not accept this status quo. Yes, there are ways to improve individual efficiency, but this is often left to the physician to seek out on her own.

Systemic changes to the electronic delivery of healthcare are desperately needed. The onus should be on manufacturers, hospital administration, and health care systems to provide tools tailored to clinician needs not just hospital billing. We would never accept F level performance from a surgeon. We must work with hospitals, EHR companies, and legislators to demand better from the systems we use to deliver care. In the meantime, physicians must control what they can in the moment and give feedback to those who can improve the systems.

What can you do? First, make sure that you are taking the necessary measures to avoid or treat burnout. Seek out opportunities to gain knowledge and skills. Ask for resources such as dictation software, scribes, or templates for common documentation types. Join a hospital committee focused on EHR or Information Technology to give feedback on what works well and what could be improved. Take a course on billing and coding to familiarize yourself with how it works. Subscribe to blogs, podcasts, or other publications that teach physicians about how to interact effectively with the EHR and other digital healthcare delivery tools.

EHR and Health IT Learning Resources:

University of Minnesota Interprofessional Healthcare Informatics Online Course 

AMA Health Systems Science Textbook

AMIA Clinical Informatics Certification

 

 

Lillian Erdahl, MD FACS is an Assistant Professor of Surgery at the University of Iowa. She serves as Associate Program Director in General Surgery as well as the head of the Iowa City VA Medical Center Breast Clinic. Her research interests include breast cancer prevention, faculty development, and simulation in teaching clinical examination. She is the Communications Director for the University of Iowa Department of Surgery which includes overseeing the department’s social media accounts. Her work for Gender Equity includes serving as the Association of Women Surgeons Communications Committee Co-Chair. Outside of the hospital, she enjoys yoga, cross-country skiing, cooking, and gardening.

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Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.

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