While ophthalmologists are using electronic health records at an unprecedented level, they are seeing declining financial and clinical productivity from their EHR systems.

That’s the finding of a new study published last week in the journal of JAMA Ophthalmology. Funded by the American Academy of Ophthalmology, it is the third in a series of three questionnaire-based surveys conducted in 2006, 2011 and most recently 2016.

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Although the EHR adoption rate rose to 72.1 percent from 47 percent since the previous EHR survey of U.S. ophthalmologists in 2011, respondents in the latest survey were more decidedly negative in their perceptions of the effects of EHRs on productivity outcomes and practice costs.

When it came to perception of productivity changes (number of patients seen per day) after EHR adoption, about 54 percent of ophthalmologists in the 2016 survey reported a decrease in clinical productivity compared to 32 percent of respondents in the 2011 survey.

In addition, the perception of increased practice costs after EHR adoption grew from 40 percent in the 2011 ophthalmology survey to about 75 percent in the 2016 survey.

“There’s a lot of disgruntlement out there,” says lead author Michele Lim, MD, vice chair and medical director of the University of California-Davis Eye Center. “The survey did show that overall the response to some of these questions about finances and clinical productivity were more negative than before.”

Nonetheless, Lim points out that despite their overall dissatisfaction “only one-third of ophthalmologists surveyed said that they would return to paper records if they could, and more than half said they would not.”

At the same time, the authors note that one of the limitations of their study is that the 2016 survey only asked about perceptions and that no data were actually collected to validate reported financial or clinical productivity changes.

“Our findings highlight the fact that companies that design EHR systems should further address the efficiency and usability of those systems,” adds Lim, who points out that Epic Systems was the vendor used by most survey respondents, followed by NextGen Healthcare. “In a perfect world, EHR systems would help providers deliver efficient patient care and include a positive, user-friendly interface. EHR technology is evolving, and we will end up with such systems if appropriate stakeholders, including healthcare professionals who use EHR, and those who design them work together.”

More than half of ophthalmologists in the survey indicated that they had attested to Stage 1 Meaningful Use, and about 80 percent of respondents who had attested to Stage 1 MU said they had either already attested or were planning to attest to Stage 2—9 percent had no plans to do so.

While a significant proportion of respondents in the survey indicated that they are engaged in federal EHR incentive programs, the cost and complexity of the programs are potential barriers to participation, according to Lim.

Further, she observes that between the 2011 and 2016 surveys there was a decline in physician documentation via typing and dictation and an increase in the use of medical scribes. Going forward, Lim plans to conduct a survey of physician perception focused on the effects of using medical scribes to assist them with EHRs in their practices.

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