Doctors' Dissatisfaction With EHRs May Be 'Early Warning of Deeper Quality Problems'

Susan Jones | October 18, 2013 | 11:17am EDT
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Electronic health records (EHRs) are a source of frustration to many physicians, says a new study conducted by the RAND corporation and commissioned by the American Medical Association. (AP File Photo)

( - Electronic health records are a source of frustration to many physicians, according to a study on physician satisfaction sponsored by the American Medical Association.

The findings could serve as an "early warning of deeper quality problems developing in the health care system," the AMA said.

The study, conducted for AMA by the RAND Corporation, found that doctors who perceived themselves or their practices as providing high-quality care reported better professional satisfaction.

Electronic health records (EHRs) were a source of both promise and frustration, the Rand study found.

Although physicians tend to like the concept of EHRs, those surveyed said that current EHR technology interferes with face-to-face discussions with patients; requires physicians to spend too much time performing clerical work; and degrades the accuracy of medical records by encouraging template-generated doctors' notes.

In addition, doctors worry that the technology has been more costly than expected; and different types of electronic health records are unable to "talk" to each other, preventing the transmission of patient medical information when it is needed.

"Physicians believe in the benefits of electronic health records, and most do not want to go back to paper charts," said Dr. Mark Friedberg, the study's lead author and a RAND scientist. "But at the same time, they report that electronic systems are deeply problematic in several ways. Physicians are frustrated by systems that force them to do clerical work or distract them from paying close attention to their patients."

AMA noted that some medical practices are experimenting with ways to reduce physician frustration by hiring additional staff members to perform many of the tasks involved in using electronic records, such as data entry.

Under the Health Information Technology for Economic and Clinical Health (HITECH) Act, doctors, health care professionals and hospitals can qualify for Medicare and Medicaid incentive payments when they adopt and "meaningfully use" EHR technology.

As previously reported, billions of dollars already have been spent to encourage EHR use.

Health and Human Services Secretary Kathleen Sebelius has said that EHRs will lead to "more coordination of patient care, reduced medical errors, elimination of duplicate screenings and tests, and greater patient engagement in their own care."

To address patients' privacy and security concerns, HHS's Health Resources and Services Administration has a Web page dedicated to helping health care organizations protect patients' electronic records, which will include sensitive personal information.

Other findings from the RAND study include:

-- Excessive productivity quotas and limitations on the time spent with each patient were major sources of physician dissatisfaction.

-- Physicians described the cumulative burden of rules and regulations as being overwhelming and draining time and resources away from patient care.

-- Perceptions of collegiality, fairness and respect were key factors affecting whether physicians were satisfied.

The AMA said its study did not identify Obamacare as having a significant effect on physician satisfaction, either positive or negative, because most physicians are still not sure how it might affect them. But AMA said it was clear that health reform will prompt physician practices "to seek economic security by growing in size or affiliating with hospitals or larger delivery systems."

The study is based on data from 30 physician practices in six states (Colorado, Massachusetts, North Carolina, Texas, Washington and Wisconsin), using a combination of surveys and interviews conducted between January and August 2013.

The report is titled "Factors Affecting Physician Professional Satisfaction and Their Implications for Patient Care, Health Systems, and Health Policy."

RAND Health describes itself as the nation's largest independent health policy research program, with a broad research portfolio that focuses on health care costs, quality and public health preparedness, among other topics.
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