Why Electronic Medical Records Are Failing To Meet Expectations

Holly May

Once celebrated as the next big thing in the healthcare world, electronic medical records (EMRs) have a long way to go in terms of physician satisfaction, according to survey data from AmericanEHR Partners released in March at HIMSS 2013.

The findings are based on 4,279 responses to multiple surveys between March 2010 and December 2012 about physician satisfaction with EMRs.  Of physicians who participated, 70% are in practices of 10 or fewer doctors and the majority intend to participate in the Meaningful Use program.  According to the study, physician disillusionment with EMR systems is growing rapidly:

• 20% of physicians are very dissatisfied with their EMR overall

• The portion of physicians who are very dissatisfied with their EMR’s ability to improve patient care doubled from 10% in 2010 to 20% in 2012.

At least some of the blame from the clinical community is directed at EMR vendors.  The lines of the refrain go something like this: “the EMR vendor rushed the implementation at the site”, or “the vendor provided insufficient training for clinicians”, or “the vendor neglected usability and user experience”, or “the new system requires so much extra time to do anything.”   Dr. Justin Graham, Chief Medical Information Officer at NorthBay Health System in Fairfield, California reports once hearing a physician comment that “with a new EMR, you can now do tasks in 30 minutes that you never had to do before!”

Chang M. Seo, Technical Lead at Kaiser Permanente who is involved in managing EMRs explains some of the growing pains with EMR adoption: “The underlying assumption is that switching to something new is better than the old way”, while “some doctors are having a hard time utilizing new EMR systems to their benefits, especially more experienced physicians.”

To further unpack what could be driving the decline in satisfaction seen in these surveys, I offer a few additional theories:

• Maximizing user satisfaction was never the primary objective: More often than not, EMRs are implemented for business reasons like reducing costs or increasing reimbursement through improved documentation. Dr. Graham explains, “physician satisfaction [is] often an afterthought during design.”  Not surprising then that user satisfaction will be low.

• Sticky EMRs, or the “good enough” issue: EMRs are technically complicated and implementation is inherently disruptive.  Graham suggests that “although customers want better products, the barrier to switching is huge, and so the EMR vendors have very little incentive to make large changes in their platforms when they are doing “good enough”.”  Hospital and office administrators are understandably reluctant to rip-and-replace old systems. Users who expect improvements (like upgrades pushed to a smartphone operating system) grow increasingly annoyed at the static nature of the systems.

• Government mandates shift composition of users: In the pre-Meaningful Use era, innovative physicians used electronic medical records that were custom-made for the institution or were optimized for niche areas like Emergency Department information systems.  These early adopters were prone to have a more optimistic outlook on their novel computer systems.  In contrast, users who joined the pool of surveyed physicians more recently may be reluctant users, reacting to the carrot-and-stick that is Meaningful Use.  As slow adopters, they are predisposed to be more critical of the tools.

This points to a giant opportunity: as electronic medical records cross from lightly used by early adopters to heavy use by mainstream physicians, products that have deep functionality and quickly implement improvements will win more physician satisfaction. Gaining physician buy-in early in the EMR process and listening to their requests and desires would go a long way toward addressing this lack of satisfaction.  Dr. Shirie Leng, an anesthesiologist at Beth Israel Deaconess Medical Center in Boston recently blogged about her wish list for EMRs, which includes:

• User-focused features like streamlined user log-ins, dashboards to centralize relevant patient data on a single tab or page, voice recognition and voice-to-text features, and ability to use wireless devices like iPads

• In addition to UI/UX elements, physicians and caregivers alike would be happier with a universal system or at least compatible systems across institutions which enable families and physicians to access data – like test results, prescriptions, and prior procedures – that are locked away in disconnected systems.

• A way to reduce the burden of documentation and data entry that falls on physicians and more so on nurses.

Here’s to hoping that one day we move to a post-EMR world where various IT systems and digital tools play nice together and where data is more easily accessed, transferred, stored, and analyzed.  Hopefully one day sooner, we’ll see big improvements in EMR technology and clinician satisfaction.

Data

Data originally shared at AmericanEHR Partners presentation at Healthcare Information and Management Systems Society 2013 Annual Conference & Exhibition; cited here from a March 18, 2013 article in AMedNews.com.