Electronic health record systems or EHRs are designed to provide easy access to patient information such as medical histories, prescriptions, lab reports and physician notes. Medical transcription companies focus on helping physicians ensure accurate EHR documentation, and importantly, help reduce the EHR-related data entry burden. Recently published research linked physician stress directly to the EHR documentation task. However, reports indicate that electronic patient charts are proving an asset during the coronavirus pandemic.
Clinician EHR Use – What Studies Found
While the goal of EHRs is to make paperwork easier, a study by researchers from the University of New Mexico (UNM) that covered 282 clinicians reported that EHRs contribute to approximately 40 percent of clinician stress (www.hscnews.unm.edu). Previous research had linked 13 percent of physician self-reported levels of stress and burnout to EHRs.
The survey helped the researchers correlate what EHR design and use features were most highly associated with respondents with high measured stress and burnout. The clinicians were asked to evaluate how their work day was affected by excessive data entry, inability to navigate the system quickly, and challenges to integrating notes into external systems. The survey findings, which were published in September 2019, showed that:
- The time that clinicians spend on medical record-keeping has doubled and extended into their home life.
- Clinicians need a 60-hour week just to keep up with documentation.
- Physicians now spend two minutes at the computer for every one minute spent with patients.
- Electronic notes affect focus on patient care – “face-to-face time with the patient has turned into face-to-screen time”
While the respondents appreciated the ability to access and update patient medical records at their convenience, they disliked how it led to after-hours EHR time.
A Yale-led study published in Mayo Clinic Proceeding journal in 2019 linked frustration with EHRs to high rates of physician burnout as well as medical errors. (www.courant.com). Concerns reported include:
- EHRs have massive structured data entry requirements, but the information doesn’t do much to improve care.
- It is very difficult to find communication from another doctor or a specific test result in a patient’s chart.
- EHRs pose significant user challenges for dermatologists, orthopedic surgeons, general surgeons and older physicians.
In May 2020, Medical Economics published the results of its 2019 EHR Scorecard conducted in October, which asked physicians the following question: “In your opinion, what is the biggest problem with EHRs across the marketplace?” The criticisms are grouped into six categories:
- Interferes with doctor patient relationship – far too much time on the computer, need to capture bullet points to bill different levels of care.
- EHR systems not designed for patient care – More useful for billing and tracking
- Lack user-friendliness – system is too cumbersome, too many clicks to search the chart, not organized physicians have been trained to organize charts, not designed with user in mind.
- Exchanging information with other EHR systems – inability to share information, for example, between physician’s office and hospital, lack of proper interfaces for export and import of data
- Impact on productivity – documentation mainly to meet insurance requirements and takes too long
- Expense – costly to upgrade and maintain, need to hire additional staff
HSS Takes Action to Reduce Physicians’ EHR Burden
In February 2021, the Department of Health and Human Services (HHS) came out with a comprehensive strategy to reduce the regulatory and administrative burden related to the use of health IT, including EHR (www.healthit.gov/buzz-blog). These recommendations and policy shifts are meant to provide clinicians with more time to focus on what matters most – caring for their patients. The report outlined three goals designed to reduce clinician burden:
- Reduce the effort and time to record health information in EHRs for clinicians;
- Reduce the effort and time required to meet regulatory reporting requirements for clinicians, hospitals, and healthcare organizations; and
- Improve the functionality and ease of use of EHRs.
Responding to clinician feedback and input, CMS has made changes to E/M documentation and coding framework that clinicians use to bill Medicare for common office visits. These changes will allow clinicians to make better use of their time and strengthen the physician-patient relationship by spending less time on documenting visits and more time on treating their patients.
COVID-19 – EHR Systems Prove an Asset to Patient Care
Experts point out that EHR systems have been more of an asset, than a burden, during the coronavirus outbreak (www.ehrintelligence.com). With their telehealth functionalities, EHR systems are helping clinicians test and manage COVID-19 patients, and reduce the spread of the virus, according to Tom Still, president of the Wisconsin Technology Council. The benefits of EHRs during the pandemic are:
- EHR systems were able to quickly respond to telehealth implementation and the need for virtual care.
- Telehealth and EHR technology have enhanced the “human aspect” in care by allowing physicians to see patients and their families remotely in their homes.
- Telehealth services have eased the overcrowding in hospitals and practices.
There are still issues to be sorted out such as lack of interoperability, not having patient data accessible in one place, and limits on who can access virtual care. However, according to the Wisconsin Technology Council president, “For many people, however, electronic health tools may be a way to fight back against COVID-19.”
As EHR-embedded telehealth grows, using medical transcription services can help busy physicians save time and labor and ensure accurate and timely records of patient interaction and care.