There is little doubt that overall EHR is improving patient care and safety. However, as could be expected from the roll-out of a new technology in a complex environment, there are some unintended negative consequences. No other industry has been known to be under a mandate to adopt a new technology before its effects are fully understood and before the technology has reached a level of usability that is acceptable to its core users.1
It is important to note that these consequences do not necessarily result from malfunctions within the EHR, but from the interactions between the EHR and the work environment or between the EHR and the technical and physical infrastructure.
Physicians recognize the important advances that EHRs allow in accessing information remotely (like checking a patient’s test results from home), availability and access to the same information at various facilities, and improvement in compliance with guideline-based care. In one study, fewer than 1 in 5 would prefer to return to paper-based medical records.1
Despite recognizing the value of EHRs, many physicians believe they are negatively impacting patient care in several important ways which is undermining their professional satisfaction. Physicians in a variety of specialties reported that their EHRs required them to perform tasks that could be done more efficiently by clerks and transcriptionists. Their specific concerns include:1
- Poor EHR usability that did not match their clinical workflows
- Time-consuming data entry
- Interference with face-to-face patient care
- Overwhelming number of electronic messages and alerts
- Inability to exchange health information electronically and continued reliance on faxed medical documents from outside providers
- Concerns about inaccuracy and potential misuse of template-based notes. Preformatted, computer-generated text can improve efficiency of data entry but contains extraneous and inaccurate information about patients’ clinical histories. Some physicians do not trust a medical record containing such notes.
- EHRs being significantly more expensive than anticipated, creating uncertainties about the sustainability of their use.
Physicians’ concerns about EHR usability correspond to those documented by Koppel,2 American Medical Informatics Association (AMIA),3 and practicing physicians.4
As of October 2013, 85% of eligible hospitals and more than 60% of eligible professionals had received a Medicare or Medicaid EHR incentive payment. Moreover, 90% of eligible hospitals and 80% of eligible professionals had taken the initial step of registering for the Medicare or Medicaid EHR Incentive Programs.5 With this rapid adoption, one would expect some growing pains, however, it is important that efforts are undertaken to address these problems through joint input from representatives of academic settings and vendors of EHR systems.
In one such effort, AMIA developed 10 recommendations in four areas: (1) human factors health information technology research, (2) health IT policy, (3) industry recommendations, and (4) recommendations for the clinician end-user of EHR software.3 These AMIA recommendations are intended to stimulate informed debate and provide better understanding on the effective use of health IT to lead to safer utilization of EHR systems.