Physician Satisfaction with EHRs: It’s Even Worse Than You Think

The Good News: Incentives Worked

As in 2012 and 2014, in 2016 Medscape surveyed physicians to determine their use of, and opinions on, their EHRs. This latest round, they surveyed 15,285 physicians across over 25 specialties. The latest report was released a few months ago, and as expected (and incentivized by the government) EHR use continues to grow:

The Bad News: Screen Time > Patient Time

And according to a recent study published in the Annals of Internal Medicine, doctors are spending an awful lot of time using those EHRs. Almost twice as much time, in fact, as they spend talking with patients: the physicians studied “spent 27.0% of their total time on direct clinical face time with patients and 49.2% of their time on EHR and desk work.”

Benefit Unknown

And is all this extra EHR time producing favorable results? Nope. On slide 18, Medscape asked docs to rate the effect of EHRs on various aspects of their practice:

  • documentation
  • patient service
  • clinical operations
  • bill collections

And here are the results:

Medscape’s take on this graph is decidedly optimistic:

While physicians have many complaints about EHRs, they also recognize the positive effects of having an EHR. Over half (56%) of our respondents said that EHRs improve documentation, and just under a third believe that they improve patient service (30%), clinical operations (32%), and bill collections (31%). On the flip side, 21% of physicians said that EHRs have made the documentation process worse, and 25% cited detriments to patient service and clinical operations. Only 7% said they make the collection process worse.

If you only read that quotation, you’d think that the docs had a pretty balanced view: a little good, a little bad. But let’s unpack the quote a little. First, here’s the evidence for physicians’ positive thoughts on EHRs:

Over half (56%) of our respondents said that EHRs improve documentation, and just under a third believe that they improve patient service (30%), clinical operations (32%), and bill collections (31%).

So almost half of respondents did not believe that EHRs even improved documentation — and sizable majorities of doctors didn’t believe they improved anything else, either! And that’s the good news?

Let’s try redrawing that graph, making a simple division between the physicians who thought EHRs had improved each category of activity, and the physicians who did not think EHRs had created improvement. And since those two groups should add up to 100% of respondents, we’ll show it as a stacked column:

To me, this presentation is a lot clearer, and a lot harder to spin positively: it’s clear that a large percentage of physicians surveyed don’t feel that EHRs have improved any aspect of their practice.

These earlier studies are echoed in the 2016 Deloitte survey of physicians, in which 70% or more physicians felt that their EHR was a net loss financially, and reduced productivity:

2016 Deloitte Physician Survey

Getting Worse, Not Better

What makes the situation worse is that according to AMA surveys (as reported by AAFP and others), satisfaction with EHRs is dropping precipitously over time:

I can’t think of any other industry in which more than five years into the move from paper to electronic records the staff felt nothing had improved, and that sentiment seems to be only getting worse.