Do More Physicians Want a Seat at the EMR Development Table?

It seems that many physicians who are pressured by meaningful use requirements want to have more say in developing new EHR systems that match their workflow and improve patient care.

Anecdotal evidence and objective studies indicate that many physicians are growing increasingly frustrated with electronic health records (EHRs). According to a RAND Corporation survey of 656 physicians in 30 practices across six states in the U.S., 43% of doctors said that electronic health records slow them down when providing clinical care, and 36% said EHRs interfere with patient-doctor communication during face-to-face clinical care.

Distracted Doctors

Physicians acknowledge the merits of using the EHR, but many doctors are complaining that these systems are turning them into clerks rather than better clinicians by taking precious time away from direct engagement with patients. Some distracted doctors are even turning to medical scribes to take care of administrative tasks so that they can focus more on their patients.

Making things easier for doctors to do their jobs—that’s one promise of electronic medical records. But with rigid “meaningful use” requirements pushing doctors to use these systems, it sometimes seems the focus has shifted to satisfying requirements rather than improving patient care.

"Physician experiences documented by the AMA and RAND demonstrate that most electronic health record systems fail to support efficient and effective clinical work," AMA President Steven J. Stack, M.D., said in a statement. "This has resulted in physicians feeling increasingly demoralized by technology that interferes with their ability to provide first-rate medical care to their patients."

Left Out of the Conversation

To make matters worse, physicians and allied health professionals—end users of EHR products—often have little say when it comes to creating EHRs, whose designs may seem to focus more on meeting MU guidelines than physician needs.

A HealthLeaders Intelligence survey of healthcare executives revealed that only “one out of four organizations involved physicians in every step of the clinical system purchase” and “less than half consulted a physician advisory board or used beta testing before implementation.”

With frustrations mounting, some doctors would like to provide more input regarding how EHRs are developed and implemented. Vendors who lack an understanding of doctors’ practices and workflow would benefit from their input.

“[Physicians] are trained to think a certain way, and you need to make the system logical for the way physicians are trained,” Dr. Peter Marzano, an internal medicine physician, told Health Leaders Media.

Making Health IT Work

Tennessee-based Health IT provider MEDHOST (formerly HMS/HealthTech) uses a 12-member physician advisory board that meets regularly to elicit input. The company says that “physician vetting” is invaluable to any EHR rollout. And if that’s successful, then physicians will likely want to solve additional challenges, like interoperability.

“It’s unique. We sit at a table with the IT guys. They ask, ‘What do you think?’ and we might say, ‘This doesn’t work because’...It is not adversarial as with some other IT firms,” Marzano said of MEDHOST’s process.

Lack of physician consultation can certainly have a negative impact on EHR implementation. As related by iHealthBeat, the “lack of clinician input and training contributed to the troubled rollout of an electronic health record system at Athens Regional Medical Center in Georgia.”

In contrast, recruiting input from clinicians during all phases of EHR implementation has proved to be a successful model. For example, The Liverpool Heart and Chest Hospital (LHCH) and Robinson Memorial Hospital implemented integrated Allscripts Sunrise electronic medical record (EMR) and OnBase enterprise content management (ECM) solutions for clinical and administrative operations across multiple locations for care delivery systems.

“The fact that the project has been so clinically led is really important to its success,” Dr. Johan Waktare, consultant cardiologist and clinical lead for EMR at LHCH, told EHR Intelligence. “The integration allows us to flexibly manage a range of disparate clinical information in a manner that is tightly integrated with our existing systems, helping us move towards fully electronic workflows and HIMSS Stage 7.”

When physicians aren’t taking a lead role in EHR rollouts, some are busy creating systems of their own. A family physician in California collaborated with his children—one a health IT consultant and the other a game theory in healthcare instructor at Stanford. Together, they created ElationEMR, a simple EHR tool for small practices. MedCityNews described it as a “‘clinical first approach’ to the electronic medical record” that was created based on small practices.       

In contrast to established EHR products that were initially created as practice management tools used for tasks like billing, ElationEMR is “not a compliance tool, to get compliance dollars,” co-founder Conan Fong told Forbes. 

Usability Priorities

Indeed, EHR vendors would benefit from listening to what some physicians have to say about how their products fail to reflect their workflow. The AMA, the largest association of physicians and medical students in the U.S. with over 200,000 members, suggests eight priorities for vendors in improving the usability of EHRs for physicians:

• “Enhance Physicians' Ability to Provide High-Quality Patient Care
• Support Team-Based Care
• Promote Care Coordination
• Offer Product Modularity and Configurability
• Reduce Cognitive Workload
• Promote Data Liquidity
• Facilitate Digital and Mobile Patient Engagement
• Expedite User Input into Product Design and Post-Implementation Feedback”

“The AMA believes that it is imperative to step back and place the EHR in the proper role,” AMA President Steven J. Sack, M.D., said in a news conference per Modern Healthcare. “Doctors find that these tools have great promise and potential, but they're very much not where they need to be.”

More input from clinicians can result in improved usability, interoperability, and ultimately, better patient care.