Docs 'stressed and unhappy' about EHRs

They complain that 'electronic systems are deeply problematic in several ways.'
By Mike Miliard
11:02 AM
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While physicians recognize the benefits of electronic health records, they also complain that many systems deployed nowadays are cumbersome to use and often act as obstacles to quality care, according to a new report from RAND Corporation.

The study makes the case that being able to provide high-quality healthcare is a primary driver of job satisfaction for doctors, and that anything that hinders that ability is a source of stress. RAND officials say the findings suggest potential early warnings of deeper quality problems developing in the U.S. healthcare system.

"Many things affect physician professional satisfaction, but a common theme is that physicians describe feeling stressed and unhappy when they see barriers preventing them from providing quality care," said Mark Friedberg, MD, the study’s lead author and a natural scientist at RAND. "If their perceptions about quality are correct, then solving these problems will be good for both patients and physicians."

The findings are from a project, sponsored by the American Medical Association, designed to identify influences on doctors' professional satisfaction – a snapshot of physician sentiment as the U.S. healthcare system moves toward new delivery and payment models.

Docs who were surveyed expressed concern 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 notes, according to the RAND report.

In addition, they worry that the technology has been more costly than expected, and cited frustrations about poor EHR interoperability, which prevents the transmission of patient data when and where it's needed.

"Physicians believe in the benefits of electronic health records, and most do not want to go back to paper charts," said Friedberg in a press statement. "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."

Medical practices reported experimenting with ways to reduce physician frustration, according to the study. Some employ additional staff members to perform many of the tasks involved in using electronic records, helping doctors’ focus their interactions with electronic health records on activities truly requiring a physician’s training.
Researchers say that physicians reported being more satisfied when their practice gave them more autonomy in structuring clinical activities, as well as more control over the pace and content of patient care. Doctors in physician-owned practices or partnerships were more likely to be satisfied than those owned by hospitals or corporations.

Health reform shifts such as the Affordable Care Act weren't seen as having prominent effects on physician satisfaction, one way or the other, according to the study. Most physicians and practice administrators were uncertain about how reform would affect their satisfaction and practice finances.

It was clear, however, that a common response to health reform was for physician practices to seek economic security by growing in size or affiliating with hospitals or larger delivery systems, according to RAND.

Other findings from the study include:

  • Excessive productivity quotas and limitations on the time spent with each patient were major sources of physician dissatisfaction. The cumulative pressures associated with workload were described as a "treadmill" and as being "relentless," sentiments especially common among primary care physicians.
  • 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. Within the practices studied, frequent meetings with other doctors and other health professionals fostered greater collegiality and satisfaction.
  • Researchers based their findings on information gathered from 30 physician practices in six states -- Colorado, Massachusetts, North Carolina, Texas, Washington and Wisconsin. In addition to surveying physicians, RAND researchers visited each practice to conduct in-depth interviews with 220 physicians, medical administrators and allied health professionals to better understand the issues that drive doctors’ satisfaction with their work lives. The practices included a wide assortment of medical specialties and organizational models.

"Overcoming modern medicine’s greatest obstacles to first-rate medical care can simultaneously enhance the quality of care and improve professional satisfaction among physicians," said AMA President Dr. Ardis Dee Hoven, in a press statement. "The AMA is committed to leading a national dialog regarding the major factors driving many physicians to feel increasingly disconnected from what really matters -- their patients."

Read more of the RAND report, "Factors Affecting Physician Professional Satisfaction and Their Implications for Patient Care, Health Systems, and Health Policy," here.

[See also: Docs adopt and adapt, yet still cling to old ways]

While physicians might still feel frustrated with EHRs, there was better news on another health IT front this week: e-prescribing.

According to research published in the new edition of The American Journal of Managed Care, more than half of those physicians who write prescriptions today do so electronically. That's nearly eight times the number who were e-prescribing just four years ago.

Led by Meghan H. Gabriel from the Office of the National Coordinator for Health IT, the researchers studied the rise in e-prescription use from December 2008 to December 2012 by examining data from Surescripts, which serves more than 240 million patients nationwide through most chain, franchise and independent pharmacies.

Data revealed that during the study period, the share of doctors, nurse practitioners and physician assistants who used e-prescriptions jumped from 7 percent to 54 percent; or 47,000 to 398,000. The share of prescriptions written electronically rose from 4 percent to an estimated 45 percent over the same period, with 86 percent of prescribers using electronic health records.

Meanwhile, the share of pharmacies able to accept e-prescriptions rose as well, according to the research. At the start of the study period, 70 percent or 43,000 pharmacies could accept electronic prescriptions, and by December 2012, 24 percent or 59,000 were able to do so.

Some of the more striking progress has been in rural areas. In 2008, only 61 percent of rural pharmacies could take e-prescriptions, compared to 75 percent of urban pharmacies. By 2012, this gap had closed (93 percent of rural and 94 percent of urban pharmacies could take e-prescriptions).