At the annual Healthcare Information and Management Systems Society (HIMSS) conference in March 2016, Andy Slavitt, acting CMS administrator, revealed the worst kept secret in healthcare: Physicians are extremely frustrated with current EHR systems.
During a keynote speech, Slavitt shared findings from eight focus groups CMS conducted with frontline physicians on EHRs. The main theme was that EHRs were not intuitive and usable for a physician's work flow. One doctor interviewed by CMS complained that it took eight clicks to order aspirin in the EHR, and it took 16 to order full-strength aspirin.
The dislike for EHR systems, especially in terms of usability, has been boiling for several years. According to a survey conducted by the AMA and American EHR Partners, a research company which rates vendors in the space, satisfaction with EHR systems among physicians dipped nearly 30 percentage points from 62 percent in 2010 to 34 percent in 2014.
"Current EHRs take too long to enter data, require we enter a number of things that do not seem to be valuable for patient care, are designed to fulfill federal programs rather than the needs of the physicians and the patients using them, and they don't display information in a way that's as usable and helpful to doctors as it should be," Steven J. Stack, an emergency physician in Lexington, Ky., and the president of the AMA, told Physicians Practice. "The final thing is they don't talk to each other. One of the big reasons to widely deploy EHRs was to share information across different sites of care and clinicians, and they simply don't do that at a widespread level." Stack also confirmed the click problem mentioned by Slavitt in the speech at HIMSS. He says one of his colleagues at AMA told him it took 20 clicks to order a flu shot. "That is not streamlining or making my life more efficient as a physician," he says.
Thomas Kuhn, senior systems architect for health policy and regulatory affairs at the American College of Physicians (ACP), says the reporting requirements for programs such as Meaningful Use require physicians to document data they wouldn't otherwise pay attention to when caring for a patient. Robert Wachter, physician and professor and interim chairman of the Department of Medicine at the University of California, San Francisco (UCSF) as well as the author of "The Digital Doctor: Hope, Hype, and Harm at the Dawn of Medicine's Computer Age," says the core problem is EHRs were not built with usability in mind or an appreciation for a physician's work flow. Moreover, he doesn't think it's a coincidence that higher rates of physician burnout have correlated with widespread EHR adoption.
It would be one thing if an unusable EHR was just a pain in the neck for physicians. As Wachter says though, these EHR-related work flow issues can lead to bigger problems. "The most disturbing thing [that can happen] are major medical mistakes … They happen all the time. In analyses of medical errors, it's clear that the category of EHR-facilitated mistakes has become very large," he says.