EHR usability issues still confront docs

EHR usability issues still confront physicians

As of early 2012, only about 10 percent of U.S. physicians were meeting meaningful use standards with their digital health record systems, according to a survey published in the Annals of Internal Medicine.

Of the 1,820 office-based primary care and specialist doctors polled, 43 percent reported having a basic EHR, although more recent data gathered by the research firm Accenture found about 90 percent of doctors currently using digital record systems.

Still, the survey and an accompanying editorial add some fuel to the debate over the current, varying state of EHR usability and functionality.

As of early 2012, only 9.8 percent of the physicians surveyed were meeting meaningful use standards, and for those that were, “using computerized systems for the panel management tasks were difficult,” the researchers, including Mathematica Policy Research’s Catherine DesRoches and the Commonwealth Fund’s Anne-Marie Audet, MD, wrote in their conclusion. “Using EHRs as simple replacements for the paper record will not result in the gains in quality and efficiency or the reductions in cost that EHRs have the potential to achieve.”

Their findings on “availability and perceived ease of use of systems that can help to manage patient populations should be of concern to policymakers,” the researchers wrote, referring also to some clinician dissatisfaction with system functionality, following another recent survey finding almost one-third of providers mulling a switch in their EHR systems.

Among the respondents who were just shy of meeting meaningful use standards, 41 percent were unable to generate quality metrics, 36 percent were unable to offer patients post-visit summaries and 42 percent could not exchange digital patient data with physicians outside their practice. A majority of the physicians polled also had fairly pessimistic views on the impact of EHR adoption, with about half expecting no beneficial effects on quality, cost or efficiency.

“This study shows that if EHRs are to fulfill their promise, we must shift from cheering health information technology implementations to demanding health information technology utility,” wrote University of Pennsylvania medical sociologist Ross Koppel in an Annals of Internal Medicine editorial.

Correcting the problems encountered by physicians and health systems “will require redirection of our focus on data standards and integration,” Koppel wrote. The U.S. government pays for nearly half of all healthcare in the country, and federal regulators “have authority to demand data standards and interoperability,” he noted.

With Farzad Mostashari, MD, making the public case for health IT standards, the Office of the National Coordinator for Health IT (ONC) has included interoperability as a core component of meaningful use Stage 2, and the ONC’s Health IT Policy Committee is working on an industry consensus for common sets of standards that, among other things, would make sharing data easier for providers. (Mostashari and his ONC predecessor, David Blumenthal, MD, the president of the Commonwealth Fund, also served on a review panel of the Annals survey.)

And with physician and provider dissatisfaction more palpable these days, health IT companies are trying to improve their systems’ clinical functionalities — to give clinicians documenting patient encounters the type of intuitive, efficient experience consumers have come to expect in smartphones, tablets and laptops — instead of focusing on billing and compliance functions.

Concluding the Annals survey, DesRoches and Audet wrote that “when physicians and others can use and take advantage of the full scope of the EHR’s functionalities, they may be more likely to improve the quality, efficiency and patient-centeredness of the care they deliver.”

As Mostashari said recently, explaining a few ways digital records can be used for patient engagement and clinical process improvement: “We’re about halfway through the process of computerizing and digitizing America’s hospitals and doctor’s offices, and we’re about 5 percent of the way through changing workflows and redesigning care to take advantage of those technologies.”