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Fear, Loathing, and Documentation. Why Do Doctors Still Say They Hate EHR?

Posted on August 29, 2017 I Written By

The following is a guest blog post by Daniel Sabido, Director of Product Marketing at CareCloud.

It’s been 10 years since the start of the modern EHR era. Why do doctors still report hating the technology so much? Electronic health records (EHR) have been fairly universally villainized in surveys of physicians. Here’s a recent sampler for you:

  • 54% of physicians reported being unhappy with their EHR system in 2014, according to an American EHR survey.

  • 82% of users in a survey by Peer 60 said they would actively discourage other medical professionals from using one particularly hated EHR vendor.

  • Physicians blame EHR for lost productivity — spending more time on documentation (85%) and seeing fewer patients (66%) in an IDC report on tech dissatisfaction.

What’s happening in healthcare? Is EHR really the most universally despised technology in America? Or is it a scapegoat for other changes in medicine? Let’s take a closer look at a couple of key trends:

A higher standard for EHR

Crucially, not all EHRs have been created equal. For years, the health technology market was swamped with expensive, server-based systems. These antiquated platforms were easily 20 years behind your average first-generation iPhone and looked more like Windows 95 than Mac iOS 10. When Meaningful Use incentives were prescribed under the 2008 economic stimulus plan, it created a surge in adoption for a technology landscape that frankly was not ready for primetime. Medical practices and physicians were right to complain about this rushed technology.

In recent years, we’ve seen a readjustment with a hot rip-and-replace market for EHR technology. Software Advice found that the number of clinicians replacing their EHRs increased 59% between 2014 and 2015. They’re not just upgrading to better systems; these medical groups are seeing the huge advances made in other industries and moving to the cloud. Black Book Rankings reported in 2015 that 7 out of 10 small medical practices were using a cloud-based EHR.

Changing health economics

At the same time that healthcare technology has been getting better, the economic pressure on medical practices and physicians has been getting more intense. The shift to value-based care and other policy changes have increased administrative burden. “About 80% of physician burnout is really due to workflow issues…the electronic medical record has contributed to burnout as one component,” said Steven Strongwater, a rheumatologist and CEO at Atrius Health in a New England Journal of Medicine interview.

It’s not just the recording process, but how much physicians are being asked to record that is interfering with the clinical workflow. There’s an epidemic of “just one more thing” creep in regulatory policy. Asking physicians to record a relatively simple new health marker, such as smoking status, can quickly compound into an extra hour a week of work. EHR systems don’t need to just keep up, they also need to speed ahead of increasing efficiency drag in the practice of medicine.

Perception vs. reality

Health technology has undoubtedly created stress on physicians in the past decade. Research also shows tremendous benefit. Contrary to the common belief that EHR gets in the way of patient experience, research shows that patients prefer it when their physician uses a computer. A whopping 76% of patients said they prefer their doctor to use EHR over paper charts, according to a survey by the Office of the National Coordinator (ONC).

In our 2017 Practice Performance Index, we found that high-performing medical practices were twice as likely to be adopting new health technology compared to practices that were falling behind. In our upcoming Patient Experience Index, a full 85% of patients said that it was important for medical practices they visit to be “modern and up to date.”

What comes next for EHR?

I believe we’re entering a new era of EHR in healthcare. Thanks to the shift to cloud-based systems, there is a faster pace of innovation in the sector. Cloud-based systems can roll out upgrades in a few hours, instead of a few months of costly consultant-driven updates. We’re seeing a new focus on tools that intelligently streamline administrative tasks and that connect what happens inside the exam room with the patient experience outside it. The same kind of technology that helps recommend movies on Netflix and send friendly timely reminders on Runkeeper are coming to healthcare, helping physicians provide a better patient experience and improve overall outcomes.

There are also new risks emerging to this rosy future. Meaningful Use created bad behaviors in the EHR market — the kinds of rote, administrative bulk that led to physicians despising their systems. MACRA could be heading down the same path. Can health technology companies stop history from repeating this time?

At the end of the day, patients want their doctors to be using modern technology, and patient satisfaction is a crucial part of the shift to value-based care economics. Physicians who want to be successful in their practice will need to find a way to love their EHR — or look for one that can keep up with new demands. It’s up to those of us in the health technology sector to meet them halfway.

About Daniel Sabido
Daniel Sabido is CareCloud’s Director of Product Marketing, where his responsibilities span the entire portfolio of products, and is particularly focused on identifying trends that will affect the performance of medical groups across the country. Previous to joining CareCloud, he was an Engagement Manager at OC&C, a global management consultancy, based in their London HQ where he focused on B2B clients. Daniel has also held strategic planning roles at McCann Worldgroup in New York and at the Monitor Group as a consulting analyst.

Daniel holds an MBA with Distinction from the London Business School and completed his undergraduate at the University of Pennsylvania’s Wharton School with majors in Finance and Operations.

2015 – The Year Doctors Got Pissed Off

Posted on December 31, 2015 I Written By

John Lynn is the Founder of the blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of and John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

My mother-in-law would be angry at me for the title of this post, but I think it’s the best description of how doctors feelings have changed in 2015. Most of the doctors I talk to are really pissed off with the state of healthcare. This has been coming for years though. I remember years ago talking to my orthopedic surgeon friend (one of the highest paid specialties for those following along at home) about how his life as a doctor had changed dramatically and he wasn’t nearly as happy doing the work now as he was even a few years ago.

Back when I was talking to my orthopedic surgeon friend this was pre-MU and so much of his complaint had to do with declining reimbursement. However, now it seems that the click happy, requirements of meaningful use which add no clinical value to the doctor or patient are starting to drive everyone nuts. Additional declines in reimbursement and ICD-10 didn’t help things either. They just through gas on an already flaming fire. It’s no surprise that Physician satisfaction is at an all time low. Unfortunately, that’s not measured by Washington.

Taking the brunt of this dissatisfaction is the EHR. In some cases, EHR’s deserve the blame. Some of them are awfully implemented and poorly designed. Some of them are relics from another life that somehow are still around. I’m reminded of Mr. Histalk’s comment that healthcare is where 80s technology goes to die. I think that’s the case with many EHR software out there.

However, I also think that in many ways the EHR is just the whipping boy. The EHR takes the blame when all they did was implement the reimbursement and regulation requirements that doctors said the EHR had to implement if they wanted them as a customer. Remember that reimbursement requirements and meaningful use have very little to do with improving patient care. If they were about patient care, we’d see very different requirements and we’d see an EHR that doctors appreciated a lot more than the behemoths we have today.

Considering the path that healthcare is taking, it’s easy to see why doctors are pissed off. 2015 was a brutal year for them. We’re trying to shift business models and I predict that most doctors will be the ones caught in the cross fire. The government and payers certainly aren’t going to take cuts. Patients and doctors are each going to take it on the chin during the transition. I think most doctors see this coming and realize it’s not going to be pretty. Most are too busy churning through patients that they don’t have time to do anything about it.

While doctors are upset at all the changes and what healthcare has become, I do think there’s reason to be hopeful. I’ll write more about that tomorrow as I look at the healthcare trends which get me really excited. While healthcare has plenty of problems, one thing it has as an advantage is a crop of really amazing people. For the most part, doctors, nurses, and other healthcare staff are some of the most caring, kind, thoughtful, and helpful people I know. The few bad apples often ruin it for the majority of health care workers who really want to make your life better. This alone should be cause for optimism. Tomorrow we’ll talk about other trends which make me optimistic about health care.