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This healthcare provider has seen firsthand how poor EHR design has contributed to burnout in physicians, PAs, and other practitioners.
I am a daily user of two EHR systems. One is a community hospital based complex EHR, and one is a cloud and iPad based EHR that we use in our private practice. The private practice-based EHR is much more user friendly and adapts well to our practice.
I am what you would consider a "power-user" on our community hospital based EHR, and spend a fair amount of time helping other members of the medical staff better understand and use it. The integrated dictation, patient education, auto-population of data, and macros are just a few of the elements of the EHR that make my life easier, and has the potential of making all members of medical staff more productive in patient care.
The hospital-based EHR is the most frustrating for providers to learn and use. It goes without saying that the learning curve for our institutional EHR is steep. I have used every iteration of the present inpatient software since 2009. It would be accurate to state that this software has evolved significantly and substantially in the right direction.
EHRs were not implemented to assist provider in patient care. They were implemented to gather data for the "system," and for reimbursement of care on the institutional level. The needs of the provider were a distant and mostly secondary consideration as EHRs were implemented and modified.
To say that the mandatory use of the EHR at the hospital level, including computerized physician order entry (CPOE), was a difficult and painful process, is a gross understatement. There was much pulling of hair and gnashing of teeth. Even with training at significant levels, it took a long time to iron out all the problems. While the EHR itself can be blamed for a significant amount of problems related to the transition from a paper based to and electronic-based EHR, there was also a "skill" component. Many providers frankly just didn't have the computer skills and typing ability needed to effectively use the EHR, and all of its components.
In a recent news release, the things that I have talked about in this blog were well reflected in surveys of attendees (both vendors and users) of the 2017 Healthcare Information and Management Systems Society (HIMSS) meeting.
Physicians, PAs and other healthcare providers continue to complain that EHRs are difficult to use and require additional time to maintain and complete charting. Frankly, physicians and other healthcare providers are overwhelmed with the complexity of EHR apps, regulations that drive the necessary charting and data collected by the EHR, and the lack of skill needed to effective understand and use computers and their software.
Much is written about burnout among physicians and other healthcare providers, and I know from personal experience as well as studying the data on this subject, the EHR is contributing to that. The level of dissatisfaction among providers is high, and getting worse as we pour more and more administrative work on providers without thinking about the needs of providers.
I believe that we have the technology and expertise to solve these problems, as long as we listen to physicians, PAs, nurses, and other healthcare providers who are at the point of the sword in the delivery of healthcare in America.
At our community hospital, there has been a positive trend at this point in the evolution of the EHR. Tremendous focus and resource have been expended by our software vendor to consider the needs of the end users, nurses and patient healthcare providers. The "workflow" of the record is more linear and intuitive, dictation has been more fully integrated, log-on technology has been implemented to smooth complying with necessary security and HIPAA concerns, and mobile devices have been more fully integrated.
Others must follow this lead, as EHR dissatisfaction is an urgent issue if we want to slow down, or reverse burnout and dissatisfaction issues among the healthcare providers in the U.S.